Transición en enfermedades inflamatorias intestinales: de la pediatría a la adultez / Transition in inflammatory bowel diseases: from childhood to adulthood

El 25% de los pacientes con Enfermedades Inflamatorias Intestinales (EII) se diagnostican antes de los 20 años. En la mayor parte de los centros del país se lleva a cabo la "transferencia" del paciente desde un centro de atención pediátrico a uno de adultos. La "transición" es un criterio de calidad con beneficios en el control de la EII reduciendo el número de recaídas, de hospitalizaciones y de cirugías. Por tal motivo hemos desarrollado un Programa Interdisciplinario de Transición entre dos hospitales de referencia nacional e internacional en EII. Materiales y métodos: Entre 1/2021 y 12/ 2022 se incorporaron 24 pacientes que ingresaron en 3 fases: Fase 1 Pacientes entre 14 y 16 años asistidos en el Hospital Garrahan (HG) con un abordaje interdisciplinario. Fase 2. A partir de los 17 años se realizaron 2 (dos) encuentros en el HG en conjunto con gastroenterólogos de adultos evaluando adherencia y autonomía y la Fase 3 llevada a cabo en el Hospital B. Udaondo (HBU) sólo con el equipo de adultos luego de 6 meses de realizada la transferencia evaluando adherencia al tratamiento, consultas a emergencias, internación y/o cirugías Resultados: Al inicio del Programa el 66% de los pacientes presentaban una actividad moderada a severa vs el 8% al finalizar la fase 3. Luego de la transferencia el 12,5% necesito ingreso a guardia e internación y un 8% tratamiento quirúrgico. El 83% de los pacientes continúan en seguimiento luego de 6 meses de haber sido transferidos (AU)

Twenty-five percent of patients with inflammatory bowel diseases (IBD) are diagnosed before the age of 20 years. In most centers in the country, the "transfer" of the patient from a pediatric to an adult care center is done. However, "transition" is a quality criterion with benefits in the control of IBD by reducing the number of relapses, hospitalizations, and surgeries. For this reason, we developed an Interdisciplinary Transition Program between two national and international reference hospitals in IBD. Materials and Methods: Between January 2021 and December 2022, we incorporated 24 patients into a three-phase program. Phase 1 involved patients between 14 and 16 years of age seen at Garrahan Hospital (HG) with an interdisciplinary approach. Phase 2 began from 17 years of age, with two meetings held at HG involving adult gastroenterologists to evaluate adherence and autonomy. Phase 3 was conducted at Hospital B. Udaondo (HBU) only with the adult team, six months after the transfer, evaluating adherence to treatment, emergency consultations, hospitalizations, and/or surgeries. Results: At the beginning of the program, 66% of the patients presented with moderate to severe disease activity, compared to 8% at the end of Phase 3. After the transfer, 12.5% of the patients required emergency department visits and hospitalization, and 8% required surgical treatment. Eighty-three percent of the patients continue in the program and are still being followed up six months after the transfer (AU)

[Detection and initial management of the systemic inflammatory response syndrome in medicine emergency room: 24 hours follow-up in a general hospital]. / Detección y manejo inicial del síndrome de respuesta inflamatoria sistémica en las urgencias de medicina: Análisis de 24 horas en un hospital general.

INTRODUCTION: Systemic Inflammatory Response Syndrome (SIRS) is a clinical situation frequently observed in Emergency Room (ER). Its early detection and supporting measures improve prognosis of these patients. AIMS: To know the incidence of SIRS among patients who come to ER, their frequency and distribution factors and the clinical evolution at 3 and 30 days. PATIENTS AND METHODS: Observational prospective simple-blind study. During 24 hours, SIRS was detected by observant doctors with an independent registry. Their management was observed. Patients from Obstetrics and Traumatology were not observed. Follow-up was done using telephonic and informatical techniques at 3 and 30 day. A descriptive analysis was done. RESULTS: There were 163 patients attended in ER; 25 of them with SIRS (15.3%), 16 were male (65%) and 9 female (35%). By ages 8 were under 30, 4 were between 30 and 60 and 13 were over. The respiratory rate was not measured in 12 of the 25 patients with SIRS (48%). An infectious etiology (sepsis) was found in 19 of those 25 (76%) patients. The most frequent criterion of sepsis was tachycardia, followed by leukocyte disorders. Support of volume and antimicrobial therapy were only started at once in 21 and 42% respectively on patients with sepsis. 15 of 25 were admitted (2 in ICU). After 3 days, 11 of 25 remained at hospital and after 30 days 2. CONCLUSIONS: SIRS is a prevalent situation in ER with a high percentage of admissions. Most of SIRS were of infectious origin (sepsis). Major attention is needed among physicians to establish a promptly diagnose and starting support measures that improve their prognosis.

Detección y manejo inicial del síndrome de respuesta inflamatoria sistémica en las urgencias de medicina. Análisis de 24 horas en un hospital general / Detection and inicial management of the systemic inflammatory response syndrome in medicine emergency room. 24 hours follow-up in a general hospital

Introducción: El síndrome de respuesta inflamatoria sistémica (SIRS) se presenta con frecuencia en Urgencias. Desde la Conferencia de Consenso de 1991, ratificada en la Conferencia Internacional de definiciones de sepsis de 2001 se define este síndrome como la adaptación del organismo tras una agresión. Su detección precoz y la instauración de medidas de soporte, guiadas por objetivos, mejoran el pronóstico de los pacientes. Objetivos: Conocer la incidencia de SIRS entre los pacientes que acuden a Urgencias, sus factores de frecuencia y distribución y su evolución clínica a los 3 y 30 días. Pacientes y métodos: Estudio prospectivo observacional, simple ciego. Se detectó la situación de SIRS mediante observadores con registro independiente, y se observó su manejo, durante 24 horas. Se excluyeron los pacientes de obstetricia y traumatología. Seguimiento: Telefónico y mediante la estación informática de pacientes a los 3 y 30 días. Análisis estadístico: descriptivo. Resultados: De las 163 asistencias se encontraron 25 pacientes con SIRS (15,3%), 16 en varones (65%) y 9 en mujeres (35%). Por edades había 8 < 30 años, 4 de 30-60 años y 13 > 60. A 12 se los 25 casos de SIRS (48%) no se les midió la frecuencia respiratoria. En 19 de los 25 casos (76%) el origen fue infeccioso (sepsis). El parámetro definitorio de SIRS más frecuente fue la taquicardia seguido del trastorno leucocitario.Tan sólo se inició precozmente la fluidoterapia y la antibioterapia en el 21 y 42% respectivamente de las sepsis. Ingresaron 15 de los 25 (2 en UCI), 3 días después permanecían 11 ingresados y 30 días después 2. Conclusiones: El SIRS es una situación clínica prevalente en Urgencias de medicina, mayoritariamente de etiología infecciosa (sepsis) quede para un número considerable de ingresos. Es necesaria una mayor sensibilización por parte del colectivo medico para establecer prontamente su diagnóstico e iniciar precozmente el tratamiento de soporte que mejore el pronóstico de estos pacientes

Introduction: Systemic Inflammatory Response Syndrome (SIRS) is a clinical situation frequently observed in Emergency Room (ER). Its early detection and supporting measures improve prognosis of these patients. Aims: To know the incidence of SIRS among patients who come to ER, their frequency and distribution factors and the clinical evolution at 3 and 30 days. Patients and methods: Observational prospective simple-blind study. During 24 hours, SIRS was detected by observant doctors with an independent registry. Their management was observed. Patients from Obstetrics and Traumatology were not observed. Follow-up was done using telephonic and informatical techniques at 3 and 30 day. A descriptive analysis was done. Results: There were 163 patients attended in ER; 25 of them with SIRS (15.3%), 16 were male (65%) and 9 female (35%). By ages 8 were under 30, 4 were between 30 and 60 and 13 were over. The respiratory rate was not measured in 12 of the 25 patients with SIRS (48%). An infectious etiology (sepsis) was found in 19 of those 25 (76%) patients.The most frequent criterion of sepsis was tachycardia, followed by leukocyte disorders. Support of volume and antimicrobial therapy were only started at once in 21 and 42% respectively on patients with sepsis. 15 of 25 were admitted (2 in ICU). After 3 days, 11 of 25 remained at hospital and after 30 days 2. Conclusions: SIRS is a prevalent situation in ER with a high percentage of admissions. Most of SIRS were of infectious origin (sepsis). Major attention is needed among physicians to establish a promptly diagnose and starting support measures that improve their prognosis

Impacto de la tuberculosis en Madrid: análisis de parámetros clínicos y epidemiológicos en un Hospital General durante 2002 / Impact of tuberculosis in Madrid: analysis of clinical and epidemiological parameters in a General Hospital during 2002

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[Bacteremic infection due to Nocardia otitidiscaviarum: case report and review]. / Infección bacteriémica por Nocardia otitidiscaviarum: revisión a propósito de un caso.

We present a case of bacteremic pneumonia caused by Nocardia otitidiscaviarum in a corticodependent COPD. Blood and sputum cultures on Mycobacterial media were positives and identification was done using 16S rDNA sequencing. In this article we review the most relevant communications about Nocardia spp infection and study the strain susceptibility using E-test.

Infección bacteriémica por Nocardia otitidiscaviarum: revisión a propósito de un caso / Bacteremic infection due to Nocardia otitidiscaviarum: case report and review

Presentamos un caso de neumonía bacteremica causada por Nocardiaotitidis caviarum en un paciente con bronconeumopatia crónica obstructiva corticodependiente. Los cultivos de sangre y esputo en medios para micobacterias resultaron positivos y la identificación se realizó mediante la secuenciación de 16S rDNA. En el presente artículo se realiza una revisión de conjunto sobre el agente etiológico y se practica el estudio de susceptibilidad de la cepa mediante la técnica de E-Test

We present a case of bacteremic pneumonia caused by Nocardia otitidiscaviarum in a corticodependent COPD. Blood and sputum cultures on Mycobacterial media were positives and identification was done using 16S rDNA sequencing. In this article we review the most relevant comunications about Nocardia spp infection and study the strain susceptibility using E-test

[Prevalence of atrial fibrillation and relationed factors in a population in the centre Madrid]. / Prevalencia de fibrilación auricular y factores relacionados en una población del centro de Madrid.

INTRODUCTION: Atrial fibrillation is the most common arrhythmia on clinical practice and an important risk factor for ictus. The aim of this study was to know the prevalence of this arrythmia in a central district of Madrid. MATERIAL AND METHODS: A retrospective study was done analysing medical records of 13,945 patients belonging to a primary care centre of Madrid. Time of study: recruitment of data from September 2000 to May 2001; analysis of data: from September 2001 to May 2002. RESULTS: We obtained a total of 425 atrial fibrillations, 348 non-valvular and 77 valvular. Global prevalence of atrial fibrillation in patients over 40 years in our area was 2.52%. (2.47% male, 2.55% female). Risk factors for atrial fibrillation more frequently found in non-valvular were high blood pressure (HBP), diabetes, ischaemic heart disease and left ventricular dysfunction. Among valvulars we found HBP, left atrial size over 45 mm and left ventricular dysfunction. CONCLUSIONS: Atrial fibrillation shows a prevalence and distribution in the studied area similar to that found in other European countries.

Prevalencia de fibrilación auricular y factores relacionados en una población del centro de Madrid / Prevalence of atrial fibrillation and relationed factors in a population in the centre Madrid

Introducción: La fibrilación auricular es la arritmia más frecuente en la práctica clínica y un importante factor de riesgo para ictus. El objetivo de nuestro estudio es conocer su prevalencia en un distrito central de Madrid. Material y métodos: Se trata de un estudio retrospectivo, analizando historias clínicas procedentes de 13.945 pacientes del centro de atención primaria. A partir de éstas, se cumplimentó un protocolo clínico-epidemiológico. Tiempo de recogida de los datos: de septiembre de 2000 a mayo de 2001; tiempo de análisis: de septiembre de 2001 a mayo de 2002. Resultados: Se obtuvieron un total de 425 fibrilaciones auriculares, 348 no valvulares y 77 valvulares. La prevalencia global de fibrilación auricular en pacientes mayores de 40 años fue de 2,52 por ciento. Por sexos, fue de 2,47 por ciento en varones y 2,55 por ciento en mujeres. Los factores de riesgo más frecuentemente asociados a fibrilación auricular no valvular fueron la HTA, diabetes, cardiopatía isquémica y disfunción ventricular. En la valvular la HTA, el crecimiento auricular mayor de 45 mm y la disfunción ventricular. Conclusiones: La fibrilación auricular presenta en la zona estudiada una prevalencia y distribución similar a la encontrada en otros países europeos (AU)

Malaria, una enfermedad en auge. Análisis del quinquenio 1997-2001 en un hospital de Madrid / Malaria, an emergent infectious disease. Analysis of the period 1997-2001 in a hospital of Madrid

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Infections in diabetic foot ulcers.

Foot ulcers and infections are common in diabetic patients. A 30-month-long descriptive study was conducted in our hospital in which we analyzed microbiological isolates of all patients admitted with diabetic foot infections. The predominant flora identified were Staphylococcus aureus and coagulase-negative Staphylococcus, followed by Enterococcus spp., Streptococcus spp., and enterobacteriaceaes. In 27 positive cultures (42%) polymicrobial flora were found. There were only 5% anaerobic bacteria. There appears to be a relationship between the sample collection system and microbiological isolates.

Dissociative experiences are related to commissions in emotional memory.

Two rival hypotheses of the link between dissociative experiences and emotional memory were tested: 1) the defence mechanism hypothesis that assumes that dissociation promotes fragmentation of emotional memory; and 2) the fantasy proneness hypothesis that claims that because of its overlap with fantasy proneness, dissociation is related to commissions in emotional memory. Undergraduates scoring high (n = 19) or low (n = 19) on the Dissociative Experiences Scale (DES) listened to an aversive story. Next, a free recall task was administered. While high dissociators made more commission errors in their free recall than did low dissociators, fantasy proneness did not account for this difference.