[Predictive factors for readmission in heart failure patients]. / Morbimortalidad de los pacientes ingresados por insuficiencia cardíaca. Factores predictores de reingreso.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a prevalent and increasing disease and represents one of the main causes of hospital admission. It is associated with an important morbi-mortality and a high rate of readmission. The objective of this study was to know the clinical characteristics of admitted patients with HF and to detect any valuable prognosis factors. PATIENTS AND METHOD: Prospective study of admitted HF patients between May'99 and May'00. Readmission rate was evaluated six months later. RESULTS: 204 patients were included with an average age of 78 (9.9) years. 66% were women. Diabetes mellitus (DM) (36.4%) and chronic obstructive pulmonary disease (COPD) (23.4%) were the most outstanding associated pathologies. Ischemic heart disease (IHD) was the most frequent etiology in 33.4% cases. Mean time of admission was 10 days. 34% patients had systolic dysfunction (SD). Men with IHD presented a higher rate of SD (p < 0.001). Mortality was 12.4%, especially in COPD patients (p < 0.011). IECAs were prescribed in 71.2% in the SD group. Readmission rate at 6 months was about 43%. Patients with renal failure (p < 0.04) and those with a more impaired functional class (p < 0.02) displayed a higher readmission rate. CONCLUSIONS: Several clinical factors determine the morbi-mortality and prognosis including an older age, associated comorbility, type of cardiopathy and presence of systolic dysfunction. All these factors are detected at the time of hospital admission.

Effect of marbofloxacin on Haemophilus parasuis nasal carriage.

Haemophilus parasuis is a colonizer of the upper respiratory tract and the causative agent of Glässer's disease in swine. This study focused on the nasal carriage of H. parasuis after treatment with marbofloxacin. Three marbofloxacin treatments (three doses of 2mg/kg body weight [bw] every 24h, two doses of 4 mg/kg bw every 48 h and 8 mg/kg bw in one single shot) were used and all of them reduce significantly (p<0.05) the nasal carriage of H. parasuis as compared to control animals. Moreover, H. parasuis was not detected in the nasal cavities of piglets after administering the highest dose. The effect of a dose of 8 mg marbofloxacin/kg bw in one shot was further studied in a farm with clinical cases of Glässer's disease using a longitudinal study. Statistically significant reduction of nasal carriage of H. parasuis was detected during the first week after treatment in comparison with the control group. However, a clear relationship between the minimum inhibitory concentration (MIC) of the different strains, their putative virulence or the treatment group (antibiotic or control) from which they were isolated was not detected. Finally, the effect induced by the antibiotic treatment on the bacterial strains seemed to be transitory, since diverse H. parasuis strains (with high and low marbofloxacin MICs) were observed 7 days after finishing the treatment.

Reflexiones preliminares sobre una aplicación científico-médica de actualidad: la clonación / Prelminar reflecctions about a present techno medical application: clonatoon / Reflexõe prelimiinares sobre uma aplicaço científico-médica de atualidaade: da clonagem

Este artículo afronta el nuevo reto que la tecnociencia médica ha abierto: la posibilidad de clonación terapéutica o reproductiva. En el presente trabajo se aborda, clara y esquemáticamente, la terminología científico médica, desde los conceptos de reproducción sexual o asexual hasta la endonucleación, pasando por los conceptos de embrión gamético, somático, de cultivo y células madres, para ir realizando un análisis de los conflictos éticos que se abren en cada caso. La última parte del ensayo se centra en el problema ético del embrión y los problemas generados por los embriones sobrantes de los procesos de fertilización in vitro, origen de una importante controversia entre la comunidad científica, que pide que sean utilizados para fines de investigación, diferentes grupos sociales que se oponen a su utilización y la ley que los declara como no utilizables para fines reproductivos cuando su viabilidad no pueda ser garantizada.

This paper reflects about the new medical technoscience challenge opened: the possibility of therapeutic or reproductive clonation. The present paper approximates the medicalscientific terminology clearly and schematically, from the concepts of sexual or asexual reproduction to endonucleation, to the concepts of germinal, somatic or in vitro embryos and stem cells, to carry out an analysis of the ethical conflicts opened in each case. The last part of the essay centers in ethical issues related to the embryo, particularly the problems generated by the surplus embryos of fertilization in vitro, origin of an important controversy between the scientific community, that would like that they be utilized for research, different social groups, that opposed to their use, and the law, that declares them unusabel for reproductive purposes when their viability cannot be guaranteed.

Este artigo confronta o novo desafio que a tecnociência médica abriu: a possibilidade de clonagem terapêutica ou reprodutiva. O presente trabalho aborda de uma forma clara e esquemática, a terminologia científicomédica, a partir dos conceitos de reprodução sexual ou assexual até a endonucleação, passando pelos conceitos de embrião gamético, somático, de cultivos e células tronco, para analisar os conflitos éticos que surgem em cada caso. A última parte do ensaio centrase no problema ético do embrião e nos problemas criados pelos embriões excedentes dos processos de fertilização in vitro, origem de uma importante controvérsia entre a comunidade científica, que pede que sejam utilizados para fines de pesquisa, diferentes grupos sociais que se opõe à sua utilização e a lei que os declara como não utilizáveis para fins reprodutivos, quando sua viabilidade não pode ser garantida.

Morbimortalidad de los pacientes ingresados por insuficiencia cardíaca: factores predictores de reingreso / Predictive factors for readmission in heart failure patients

FUNDAMENTO Y OBJETIVO: La insuficiencia cardíaca (IC) es una enfermedad de prevalencia creciente que constituye una de las principales causas de hospitalización. Se asocia con una notable morbimortalidad y un elevado índice de reingreso. El objetivo de este estudio es conocer las características clínicas de los pacientes ingresados por IC y detectar factores con valor pronóstico en esta enfermedad. PACIENTES Y MÉTODO: Estudio prospectivo de los pacientes ingresados por IC entre mayo de 1999 y mayo de 2000. A los 6 meses se valoró la tasa de rehospitalización. RESULTADOS: Se incluyeron 204 pacientes con una edad media (DE) de 78 (9,9) años. El 66% eran mujeres. La diabetes (36,4%) y la enfermedad pulmonar obstructiva crónica (EPOC)(23,4%) fueron las enfermedades asociadas más destacadas. La cardiopatía isquémica (CI) fue la etiología más frecuente (33,4%). La estancia media fue de 10 días. Se detectó disfunción sistólica (DS) en el 34%. Los varones y la CI presentaron más DS (p < 0,001). La tasa de fallecimientos fue del 12,4%; los pacientes con EPOC presentaron mayor mortalidad (p < 0,011). Los inhibidores de la enzima conversiva de la angiotensina (IECA) se pautaron en el 71,2% en el grupo con DS. La tasa de reingreso a los 6 meses fue del 43%. Los pacientes con insuficiencia renal (p < 0,04), con IC previa (p < 0,02) y con clase funcional más deteriorada (p < 0,02) tuvieron mayor índice de reingreso. CONCLUSIONES: La edad avanzada, el sexo, la cormorbilidad asociada, el tipo de cardiopatía y la presencia de disfunción sistólica son factores clínicos que determinan el pronóstico de morbimortalidad. Todos ellos son detectables en el momento de la hospitalización

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a prevalent and increasing disease and represents one of the main causes of hospital admission. It is associated with an important morbimortality and a high rate of readmission. The objective of this study was to know the clinical characteristics of admitted patients with HF and to detect any valuable prognosis factors. PATIENTS AND METHOD: Prospective study of admitted HF patients between May’99 and May’00. Readmission rate was evaluated six months later. RESULTS: 204 patients were included with an average age of 78 (9.9) years. 66% were women. Diabetes mellitus (DM) (36.4%) and chronic obstructive pulmonary disease (COPD) (23.4%) were the most outstanding associated pathologies. Ischemic heart disease (IHD) was the most frequent etiology in 33.4% cases. Mean time of admission was 10 days. 34% patients had systolic dysfunction (SD). Men with IHD presented a higher rate of SD (p < 0.001). Mortality was 12.4%, especially in COPD patients (p < 0.011). IECAs were prescribed in 71.2% in the SD group. Readmission rate at 6 months was about 43%. Patients with renal failure (p < 0.04) and those with a more impaired functional class (p < 0.02) displayed a higher readmission rate. CONCLUSIONS: Several clinical factors determine the morbimortality and prognosis including an older age, associated comorbility, type of cardiopathy and presence of systolic dysfunction. All these factors are detected at the time of hospital admission

Endocarditis tricuspídea en válvulanativa por Enterococcus faecalis / An unusual case of tricuspid endocarditis by Enterococcus faecalis in native valve

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