[Long-term survival of ischemic stroke]. / Supervivencia a largo plazo del ictus isquémico.

OBJECTIVE: Ischemic stroke is a serious vascular disease whose long term prognosis in all of its dimensions is not known. We have studied the long-term survival and its predictors after a first episode of acute ischemic stroke (atherothrombotic and cardioembolic). PATIENTS AND METHODS: A retrospective cohort study was made of patients with a first episode of ischemic stroke. The ictus was classified into atherothrombotic, cardioembolic, lacunar and undetermined. Patients were followed up for 10 years. RESULTS: A total of 415 cases (60% men) with mean age of 68.4 years, were included. Mean follow-up was 66 months (95% CI: 24-108 months). Overall survival at 10 years was 55.4% (54.9-55.9) (atherothrombotic, 57.7% vs cardioembolic, 43.7%, P=.002). In the multivariate analysis, variables related to mortality in acute ischemic stroke were age, chronic renal failure, dyslipidemia, history of heart failure, atrial fibrillation (AF), presenting as hemiplegia, signs of acute ischemia and perilesional edema in the brain scan on hospital admission. Involvement of the territory of right middle cerebral artery and treatment with statins were associated to a better prognosis. CONCLUSIONS: Survival of patients after ischemic stroke at ten year is over 40%, and atherothrombotic stroke as a better prognosis than cardioembolic one.

[Agranulocytosis from metamizole: a potential problem for the British population]. / Agranulocitosis por metamizol: un potencial problema en la población británica.

OBJECTIVE: Analyze the clinical and epidemiological features of this adverse effect and assess its incidence in the general population, especially in the British one. METHODS: A descriptive, retrospective analysis of all the patients discharged at Hospital Costa del Sol (Marbella) with a main diagnosis of dipyrone-related agranulocytosis in the Minimum Basic Data Set (MBDS) from January 1998 to December 2003. Neutropenia was defined as severe (neutrophils lower than 500/ml), moderate (500-1000/ml) and mild (1000-1500/ml). RESULTS: 13 patients developed dipyrone-related agranulocytosis, 8 of them foreign (61.5%) and 5 from United Kingdom. The rate of events was 8.33/106 inhabitants/year. With regard to British population registered in the area, the estimated rate of events was 20.4 cases/106 inhabitants/year. CONCLUSION: Dipyrone-related agranulocytosis is an adverse effect more frequent in British population, and its use must be avoided.

[Endophthalmitis and multiple brain abscess in a patient with endocarditis due to Streptococcus agalactiae]. / Endoftalmitis y abscesos cerebrales múltiples en un paciente con endocarditis por Streptococcus agalactiae.

Endogenous endophthalmitis is a rare disease caused by hematogenic germ spread from an internal focus. Infections due to Streptococcus agalactiae are infrequent in adults although new cases had been described recently associated to inmunodepression. We present a patient with endocarditis due to Streptococcus agalactiae, endophthalmitis and multiple brain abscess. We also review the literature.

[Pattern of blood levels of erythropoietin and proinflammatory cytokines in patients with anemia of chronic disorders secondary to infection]. / Perfil de los niveles séricos de eritropoyetina y citocinas proinflamatorias en pacientes con anemia de trastornos crónicos secundaria a infección.

OBJECTIVE: To evaluate the pattern of erythropoietin (EPO) and some proinflammatory cytokines in the anemia of chronic disorders (ACD) secondary to infection. METHODS: Sequential determination in serum of interleukin-1 beta (IL-1 beta), necrosis tumoral factor alpha (TNF-alpha), gamma interferon (IFN-gamma), interleukin-6 (IL-6), and erythropoietin (EPO) in 25 patients with chronic bacterial infectious diseases and ACD criteria. We evaluated the relationship of these mediators with the anemia and the iron metabolism. RESULTS: Serum EPO levels significatively decreased compared with initial values, and the last control was in normal rank (18.04 +/- 19.10 vs. 8.56 +/- 4.72 UI/mL; p < 0.001; normal rank: 4-15 mUI/mL). In the first control, there was a negative and non significative correlation between the EPO levels and the hemoglobin concentration (r = -0.115, NS), reaching significance in the last control (r = -0.446; p < 0.05). There was negative correlation between the hematocrit and TNF-alpha levels (r = 0.467; p < 0.05) and between the haemoglobin values and the log of serum TNF-alpha (r = 0.424; p < 0.001). An inverse correlation between the IL-6 levels and both, the hemoglobin concentration and the serum iron was found, and there was a direct correlation between this cytokine values and the EPO levels. CONCLUSIONS: Blunted response of erythropoietin and the action of TNF may contribute to the pathogenesis of ACD secondary to infection. Positive correlation between IL-6 and EPO suggest a proerythropoietic action of IL-6 in response to the anemia.

[HIV infection in old age: an epidemiological and clinical study in 42 patients in the Community of Madrid]. / Infección por el VIH en la edad geriátrica: estudio epidemiológico y clínico en 42 pacientes de la Comunidad de Madrid.

A cross-sectional study was conducted at diagnosis of HIV infection in 42 patients aged > or = 60 years attended in two hospitals in the Madrid Community. Clinical and epidemiologic characteristics were retrospectively analyzed. Mean age was 64 years, 38 patients (90.4%) were males, and 24 (57.1%) met the AIDS criteria at diagnosis. Risk behaviour: 14 (33.3%) heterosexuals, 13 (30.9%) homosexuals, 3 (7.1%) bisexuals, 3 (7.1%) had received blood derivatives, 2 (4.7%) transfused patients, 1 (2.3%) parenteral drug abuser, 1 (2.3%) others and 5 (11.9%), unknown. In 18 (42.8%) patients there was a delay of diagnosis of 7.5 +/- 1.2 months (range: 1.5-24 months). These patients had lymphocyte counts lower than those diagnosed without delay (102 +/- 20 vs 262 +/- 67.10(9)/l, p < 0.01). Patients without AIDS criteria had a likelihood of 15.4% of progression towards AIDS at one year. The survival rate of patients with AIDS at one year was 50.1%. Patients with AIDS and diagnostic delay had a survival rate at one year lower than that in patients without diagnostic delay (30.7% vs 77.8%, p = 0.03). In summary, a predominant sexual transmission was found in our series. Delay of diagnosis entails a greater clinical and immunologic deterioration and a lower survival at one year. Early diagnosis and therapy with anti-retroviral agents might induce a longer survival in these patients.