[Adequacy of the admissions and care provided to the patients with community-acquired pneumonia]. / Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad.

BACKGROUND: The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. PATIENTS AND METHODS: A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. RESULTS: We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. CONCLUSION: The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out.

[Clinical and therapeutic characteristics in patients with heart failure cared for in an internal medicine department]. / Características clínicas y terapeúticas de los pacientes ingresados en un Servicio de Medicina Interna por insuficiencia cardiaca.

INTRODUCTION: The Heart Failure (HF) is a very common clinic syndrome in the clinical practise, and a great sanitary social problem. In Spain, it is the main cause of hospitalization in Internal Medicine Services in patients over 65 years old, due to its high comorbidity, in many cases. OBJECTIVE: To determine the profile of admitted patients with HF to an Internal Medicine Service. MATERIAL AND METHODS: It is a retrospective and descriptive study. The following variables were analysed: sex, age, cause of admission, aetiology, risk factors, Framingham diagnostic criteria, type of HF, treatment-on-released, average stay, number of readmissions and the type of ventricular dysfunction (echocardiography). Chi-square test of Pearson or Fisher test were used as statistical methods. P < 0.05 was considered to be statistically relevant. RESULTS: 104 patients were analysed. The percentage of HF was 13.76%. 52.88% were men with an average age of 72.16 +/- 17.78 year. Average age for women was 82.92 +/- 7.24 year. The main cause of admission was dysnea (74%). Hypertension was the principal risk factor (70.13%). When it comes to aetiology, HTA (68.57%) was the main one. Global and left HF (33.65% either) were the most common type of HF. 5.17% of women and 20.69% of men suffered from systolic dysfunction (p < 0.023). 32.76% of women and 41.38% of men had diastolic dysfunction. The base treatment-on-release for the majority of patients consisted of diuretics and digoxin. Patients stayed 15.49 days on average, and the number of readmitted ones came up to 26.67%. CONCLUSIONS: The diagnosis and treatment of HF in an Internal Medicine Service is acceptable. It will be very important to promote the use of beta blockers and angiotensina-converting enzyme inhibitors.

[Degree of fulfillment of the objectives of metabolic control and cardiovascular risk factors in patients with type 2 diabetes in an area of primary attention]. / Grado de cumplimiento de los objetivos de control metabólico y de los factores de riesgo cardiovascular en pacientes diabéticos tipo 2 en un área de Atención Primaria.

UNLABELLED: Diabetes mellitus type is one of de most important health problem in the world, due to its high prevalence and morbidity and its relation with several cardiovascular risk factors. That s why a global action, aimed to prevent these vascular syndromes, is needed. OBJECTIVE: the goal of this study is to detect and determine how cardiovascular risk factor are controlled in diabetic type 2 patients, according to the date supplied by several international organization that have been studied at a Health Centre of Valladolid. METHODS: It is a descriptive cross-sectional study to evaluate the control of several cardiovascular risk factors in diabetic patients according to the different established criteria. The sample is formed by 74 adult patients (41 men and 33 women), included in the Diabetes Mellitus Program at Health Centre of Rondilla 2, at East Area of Primary Care of Valladolid, in the programmed consultation of cardiovascular risk factors control. RESULTS AND CONCLUSION: I has been observed that the majority of these cardiovascular risk factors are not well controlled. In this way, stringent measures of control should be considered in order to prevent the cardiovascular complications related to them.

[A case of DIDMOAD syndrome with urologic symptoms]. / Un caso de síndrome de DIDMOAD con afectación urológica.

A new case of DIDMOAD syndrome is reported on. A complete description is given and the sequential associations are detailed; highlighting the fact that the frequently associated urinary alterations should be considered as part of the same disease.

[Evaluation of metabolic control in a summer camp for diabetic children (Villarcayo 1991)]. / Evaluación del control metabólico en una colonia de niños diabéticos (Villarcayo 1991).

The relevance of the diabetological education in the treatment of diabetis mellitus must be a prioritary goal in order to reach a proper metabolic control and to avoid as much as possible both acute metabolic complications and long-term vascular and neurological complications, achieving thus a total integration of the diabetic patient in the society. We have monitored during 15 days a group of diabetic children with IDDM in a summer camp, assessing in all of them several clinical and biochemical parameters. The results have been statistically analyzed using the Student's test. After the stay in the summer camp, we observed a significant reduction in the total dose of insulin (p < 0.001) and in the number of hypoglycemias (p < 0.001) and an increase in the average levels of capillary glycemia at the end of the study period when compared with the beginning, with p < 0.001 (breakfast preprandial), p < 0.05 (lunch preprandial) and p < 0.01 (dinner and night preprandial). We did not observe any significant differences in the other parameters studied. In inclusion, the stay in the summer camp of this group had a positive effect, achieving a better metabolic control with lower doses of insulin.

[Fahr's disease and hypocalcemic syndromes. Presentation of a clinical case]. / Enfermedad de Fahr y síndromes hipocalcémicos. A propósito de un caso clínico.

A clinical case of a man with calcification of basal ganglions (CBG) is presented. The first manifestations of this syndrome were loss of consciousness and convulsions. The potential causes of his hypocalcemia, Fahr's syndrome, myocardiopathy of hypoparathyroidism and hypocalcemia are reviewed and a study oriented to autoimmune polyendocrinopathy is performed.

[Urgent care of the diabetic patient in the province of Valladolid]. / Asistencia urgente del paciente diabético en el área este de la provincia de Valladolid.

OBJECTIVE: To know the cause of admissions of diabetic patients at an emergency room in eastern Valladolid in a year. METHODS: It is a retrospective and transversal study that analysed a number of the admission of diabetic patients at an emergency room because of a direct complication of diabetes mellitus or another different cause. We used t and chi 2 as statistic tests, considering 0.05 as significance. RESULTS: Up to 2,433 (2.4%) were diabetes mellitus emergencies. 17.1% because of a direct complication, most of them metabolic complications (24.6% hyperglycaemia). CONCLUSION: We emphasize the high prevalence of direct complications as emergency admissions in our hospital.

[Etiologic prevalence of superior vena cava syndrome]. / Prevalencia etiológica del síndrome de vena cava superior.

OBJECTIVES: Superior vena cava syndrome (SVCS) is an uncommon disease which receives usually bad prognostic. In order to study the prevalence of the different etiologies we have reviewed retrospectively 17 documented cases of SVCS in the last 5 years. METHODS: The range of age was between 43 and 80 years Sex distribution was 16 males and 1 female. RESULTS: Malignant pathology was by large the most common etiology. Oat cell and squamous cell carcinoma account each for 20%, adenocarcinoma for 18%, undifferenciated carcinoma for 12% and Hodgkin's disease for 6%. Among the benign causes we have found a case of retroesternal goiter.

[Observational study of patients admitted to an Internal Medicine service]. / Estudio observacional de los pacientes ingresados en un Servicio de Medicina Interna.

OBJECTIVES: To analyse the entered more frequent disease in an Internal Medicine Department, the reasons for hospital admission diagnosis at discharge (according to entrance symptom's guide), the group of affected population and its correlation among them. PATIENTS AND METHODS: Over a total of 758 internal medicine admissions of the University Hospital of Valladolid during the year 1999 based on the information of discharge and clinical histories, a descriptive and observational epidemic study was made using the variables of sex, age, reason for admission (guide symptom) and diagnosis at discharge. The obtained results were represented by mean of diagrams of sectors and bars according to the analyzed variables. The data synthesis was made by measures of central tendency and dispersion. SPSS 10.0 version for windows program was used for the statistical study. The non parametric analysis for independent samples was made by the test of median and the U of Mann Whitney, and the parametric by chi-squired test and resistance of Kolmogorov-Smirnov. RESULTS: The median of age is 70 years. Rank 84 years. Interquartile rank 23, fashion in men 75 years and in women 86. The distribution in sex men 51%, women 49%. The more frequent reasons for entrance are dyspnea (35%) and neurological focus (11%). The more frequent diagnosis at discharge are dyspnea and chronic obstructive lung disease worsened by respiratory infection (11%), pneumonia (8%) and acute ischemic stroke (7%). CONCLUSIONS: In-patients in this service, are advanced in years (mainly women) (alpha = 0.05). The age does not get a normal distribution (alpha = 0.05). The frequency of the distribution in sex is similar. The most frequent reason for admission is dyspnea (35%). The most frequent diagnoses at discharge are chronic obstructive lung disease (11%), pneumonia (8%) and acute ischemic stroke (7%). The primary and secondary prevention and an improvement of the therapeutic measures of chronic cardiopulmonary disease would reduce significantly the welfare pressure in Internal Medicine Department and they would improve the population's life quality given that we are opposed to the diseases which are among the four first mortality causes in the world.

[Insulin-dependent diabetes mellitus and arterial hypertension]. / Diabetes mellitus insulinodependiente y tensión arterial.

Blood pressure variations of 30 insulin-dependent diabetic patients free of complications, and aged between 14-35 years have been studies, comparing their results to those from a control group formed by healthy person of the same age and physical features. Median systolic pressure of diabetic population was 120 +/- 11.07, compared to 112.90 +/- 11.31 from control group. The median diastolic pressure of diabetic population was 76.76 +/- 10.12 and 67.40 +/- 7.94 of the control group. A significant difference on systolic (p less than 0.05) and diastolic (p less than 0.001) pressures were observed in insulin-dependent diabetic patient comparing their results to those from the control group.

[Changes in metabolic parameters and microalbuminuria in patients with type 2 diabetes treated with acarbose]. / Modificación de los parámetros metabólicos y microalbuminuria en pacientes con diabetes tipo 2 tratados con acarbosa.

OBJECTIVE: To determinate the influence of the acarbosa and microalbuminuria on metabolic parameters in patients diabetics type 2. RESEARCH DESIGN AND METHODS: We are studied 92 patients with diabetes type 2, treated with Acarbose alone or with insuline or oral anti-diabetics We are determined the values of HbA1c, total cholesterol, HDL, LDL, triglycerides and microalbuminuria, before and after or the treatment with acarbose. RESULTS: The patients presented globally a statistically significant improvement in the levels of Hb A1 c, triglycerides and microalbuminuria. In the group treatise with 300 mg/day of acarbose it was observed a significant decrease of the values of Hb A1c and triglycerides independently of the associated treatment. In the group treated with 150 mg/day the improvement only it was statistically significant for the levels of Hb A1c. CONCLUSIONS: The treatment with acarbose produces an improvement in the levels of Hb A1c independently of the administered dose and of the triglycerides in patients treated with 300 mg/day without relation to associated treatments. Therefore, he acarbose win be considered an effective medication to improve the metabolic control to prevent the cardiovascular risk in those patients.

[Acute pleuropericarditis and cardiac tamponade as extraintestinal complications of ulcerative colitis]. / Pleuropericarditis aguda y taponamiento cardíaco como complicaciones extraintestinales de la colitis ulcerosa.

Pericarditis and cardiac tamponade are very rare complications of inflammatory disease of the bowel. A case of a patient with ulcerative colitis, who subsequently developed pericarditis, cardiac tamponade and pleural effusion during a latent phase of the baseline disease, is presented. At the same time, the papers published on this subject are reviewed. The presence of dyspnea, tachypnea, of pleuritic pain in patients with ulcerative colitis must be taken into consideration, and all the tests necessary to study a pleuropericardial pathology should be performed.

[Thyroid function study in patients with diabetes mellitus]. / Estudio de la función tiroidea en pacientes afectos de diabetes mellitus.

We study 48 compensated diabetic patients, 41.6% of whom were male, 68.75% had diabetic neuropathy and/or vascular complications (macro-microangiopathy). In 60.4% of the patients the study began at ten years of disease evolution. We selected 14 healthy adults as a control group, 50% being male. Plasma levels of T3, T4 and TSH were measured by RIA and the antimicrosomal antibody (AMT) and antithyroglobulin antibody (ATG), detected by passive hemagglutination. A significant decrease in T3 level (p less than 0.05) was found in controlled diabetic patients, compared to T3 levels of the control group; there was a significant reduction in T3 level (p less than 0.05) in diabetic patients with vascular disease and in female diabetics (p less than 0.05), compared to the control group. There were no statistically significant differences in the other groups, including other parameters measured. We concluded that there is a decrease of T3 in all diabetic patients, this being more noticeable in diabetic females and diabetic patients with vascular disease.

[Fibronectin as a diagnostic marker in several determined neurological diseases]. / Fibronectina como marcador diagnóstico de determinadas enfermedades neurológicas.

OBJECTIVE: To determinate if fibronectin in CSF can be a useful parameter in the diagnosis of some neurologic illnesses. MATERIAL AND METHODS: We have studied 30 patients, subdivided in four groups, depending on the type of neurologic illness. We have chosen as control a 10-patient group, which came to the Emergency Service and were diagnosed as a suspicious of neurologic illness, but after this it was discarded. In the whole group we practiced a lumbar puncture, with cytology, systematic, biochemistry, cultures, immunoglobulins determination and fibronectin quantification by ELISA. RESULTS: We want to emphasize the increase in fibronectin levels in CSF in both the patients with bacterial meningitis and the multiple sclerosis groups, when it's compared with the control group. CONCLUSION: For this, the determination of fibronectin levels in CSF might be a useful parameter in the diagnosis of some neurologic illnesses.

Comparison of drug survival rates for tumor necrosis factor antagonists in rheumatoid arthritis.

BACKGROUND: Persistence of anti-tumor necrosis factor (TNF) therapy in rheumatoid arthritis (RA) is an overall marker of treatment success. OBJECTIVE: To assess the survival of anti-TNF treatment and to define the potential predictors of drug discontinuation in RA, in order to verify the adequacy of current practices. DESIGN: An observational, descriptive, longitudinal, retrospective study. SETTING: The Hospital Clínico Universitario de Valladolid, Valladolid, Spain. PATIENTS: RA patients treated with anti-TNF therapy between January 2011 and January 2012. MEASUREMENTS: Demographic information and therapy assessments were gathered from medical and pharmaceutical records. Data is expressed as means (standard deviations) for quantitative variables and frequency distribution for qualitative variables. Kaplan-Meier survival analysis was used to assess persistence, and Cox multivariate regression models were used to assess potential predictors of treatment discontinuation. RESULTS: In total, 126 treatment series with infliximab (n = 53), etanercept (n = 51) or adalimumab (n = 22) were administered to 91 patients. Infliximab has mostly been used as a first-line treatment, but it was the drug with the shortest time until a change of treatment. Significant predictors of drug survival were: age; the anti-TNF agent; and the previous response to an anti-TNF drug. LIMITATION: The small sample size. CONCLUSION: The overall efficacy of anti-TNF drugs diminishes with time, with infliximab having the shortest time until a change of treatment. The management of biologic therapy in patients with RA should be reconsidered in order to achieve disease control with a reduction in costs.

[Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid]. / Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid.

OBJECTIVES: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. MATERIALS AND METHODS: Observational study of descriptive cross-field of a sample of 557 adolescents (14-18 years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole´s cutoff points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacy ratio. RESULTS: Excess weight is similar in both sexes (17%), but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. CONCLUSIONS: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E.

Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid / Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid

Objetivos: Descripción de las características antropométricas de una muestra de adolescentes de Valladolid junto al análisis de ingesta dietética del grupo de población. Material y métodos: Estudio de campo observacional descriptivo transversal, de una muestra de 557 adolescentes (14 - 18 años), seleccionada por muestreo probabilística de entre 6 institutos públicos y privados, de distintos barrios de Valladolid. Se realizó un cuestionario de frecuencia de consumo junto a la medición antropométrica. La clasificación de los individuos se realizó mediante el cálculo del Z-score del Índice de Masa Corporal (IMC),los puntos de corte para el IMC de Cole y criterios de la International Diabetes Federation (IDF). El análisis nutricional se realizó mediante un enfoque probabilístico y el índice de adecuación nutricional. Resultados: El exceso de peso es similar en ambos sexos(17%), sin emabargo existe un 15,2% de prevalencia de bajo peso entre las mujeres estudiadas, frente al 4,5% en varones(p<0,005). El 1,3% presentan riesgo de padecer síndrome metabólico. El consumo energético se distribuye: 30-32% lípidos, 45% hidratos de carbono y 16-17% proteínas. La valoración nutricional refleja probable déficit de consumo en yodo, zinc, vitaminas A y E. Conclusiones: La prevalencia de obesos está próxima ala de otras series, pero la prevalencia de sobrepeso es inferior. Es muy importante el porcentaje de mujeres con IMC por debajo de lo normal para su edad y sexo. Existe un exceso de aporte proteico, de grasas saturadas y de colesterol, con un déficit en el consumo de hidratos de carbono, yodo, zinc y vitaminas A y E (AU)

Objectives: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. Materials and methods: Observational study of descriptive cross-field of a sample of 557 adolescents (14 - 18years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole`s cut off points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacyratio. Results: Excess weight is similar in both sexes (17%),but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. Conclusions: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E (AU)