Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado / Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome

Objetivos. Analizar la influencia de los factores epidemiológicos y sociodemográficos en el síndrome de abstinencia alcohólica (SAA) complicado. Material y métodos. Estudio multicéntrico, observacional, prospectivo de enfermos consecutivos con SAA ingresados en servicios de Medicina Interna. Se registraron datos sociodemográficos, epidemiológicos, clínicos y evolutivos. Se definió SAA complicado como aquel que había cursado con convulsiones o delirium tremens. Resultados. Se estudiaron 228 episodios de SAA en 219 pacientes. La edad media fue de 54,5 años (DE 11,5), y el 90,8% fueron hombres. El SAA fue la causa de ingreso en el 39,9%. El 27,1% de los casos presentaron crisis comiciales y el 32,4% delirium tremens. La cantidad ingerida de alcohol diaria fue 17,8 unidades de bebida estándar (DE 21,4), con 16,6 años de dependencia (DE 11,3). El patrón de abuso de alcohol fue regular en el 82,8%. Vivían casados o en pareja el 38,4% y el 45,6% tenía hijos. Un 72,7% estaba en paro o era pensionista. El 68,5% solo habían cursado estudios primarios. El 4,8% consumía cannabis, 5,2% cocaína y 3% opiáceos. Las variables independientes relacionadas con SAA complicado fueron: consumo de alguna droga diferente del alcohol (OR 5,3; IC 95% 1,5-18,7), bajo nivel de estudios (OR 3,4; IC 95% 1,6-7,3) y el ingreso por SAA (OR 2,9; IC 95% 1,5-5,6). El área ROC del modelo fue de 0,718 (IC 95% 0,643-0,793). Conclusiones. El consumo concomitante de otras drogas de abuso y el nivel bajo de estudios pueden ayudar en la identificación de pacientes con riesgo de SAA complicado (AU)

Objectives. To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). Material and methods. A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens. Results. We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793). Conclusions. Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS (AU)

Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome. / Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado.

OBJECTIVES: To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). MATERIAL AND METHODS: A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens. RESULTS: We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793). CONCLUSIONS: Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS.

Dabigatrán: experiencia en la práctica clínica habitual / Dabigatran: experience in standard clinical practice

Introducción y objetivos. Dabigatrán es un fármaco anticoagulante, inhibidor directo de la trombina, aprobado para la prevención de ictus isquémico secundario a fibrilación auricular no valvular. El objetivo de este estudio fue determinar la eficacia de dabigatrán en la práctica clínica para la prevención de eventos isquémicos cerebrales asociados a fibrilación auricular no valvular, así como su perfil de tolerancia y seguridad. Material y métodos. Estudio descriptivo y retrospectivo en el que se incluyó a todos los pacientes que iniciaron tratamiento anticoagulante con dabigatrán entre los meses de noviembre de 2011 y septiembre de 2012. Se realizó seguimiento desde el comienzo del tratamiento hasta junio de 2013. Se determinó la incidencia de eventos isquémicos de origen cerebral, cardíaco y periférico, así como la aparición de efectos adversos y complicaciones hemorrágicas, determinando su localización y gravedad. Resultados. Se analizó a 316 pacientes con una edad media de 76,46±8,37 años, de los que el 53,5% eran varones. Dos pacientes (0,55/100 pacientes-año) presentaron ictus isquémico (incluyendo una amaurosis fugax). Ocho (2,18/100 pacientes-año) tuvieron un evento adverso isquémico, que fue de origen cardíaco en 5 (1,36/100 pacientes-año) casos y periférico en 3 (0,81/100 pacientes-año). Cuarenta (10,91/100 pacientes-año) tuvieron una complicación hemorrágica: 32 hemorragias menores (8,73/100 pacientes-año) y 8 mayores (2,18/100 pacientes-año). Conclusiones. Dabigatrán en la práctica clínica habitual es eficaz en la prevención de ictus y presenta un perfil de seguridad similar al reportado en los ensayos clínicos (AU)

Introduction and objectives. Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. Material and methods. A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. Results. We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. Conclusions. Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials (AU)

Dabigatran: Experience in standard clinical practice. / Dabigatrán: experiencia en la práctica clínica habitual.

INTRODUCTION AND OBJECTIVES: Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. MATERIAL AND METHODS: A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. RESULTS: We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. CONCLUSIONS: Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials.

Reactivación de hepatitis B tras tratamiento con CHOP y rituximab / Reactivation of hepatitis B after treatment with CHOPand rituximab

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Fiebre y exantema maculopapular como primeras manifestaciones de linfoma / Fever and maculopapular exanthema as first manifestation of lymphoma

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[Epidermiology of alcohol withdrawal syndrome. Mortality and factors of poor prognostic]. / Epidemiología del síndrome de abstinencia alcohólica. Mortalidad y factores de mal pronóstico.

INTRODUCTION: Patients with alcoholism and alcohol withdrawal syndrome (AWS) have a worse prognostic. METHODS: We have performed a retrospective analysis of the hospital discharges in with diagnosis include AWS from 1 of January of 1997 to the 31 of December of 2002. RESULTS: We identified 924 hospital stays with 2.4% of mortality (1.6% in Internal Medicine). Mortality is associated with greater age (57 years +/-15 vs. 49+/- 13, p < 0.005), with the diagnostic of hepatic cirrhosis (6.2 vs. 1.8%, p < 0.005), bacteraemia (10 vs. 1.8%, p < 0.001) and respiratory infection (9.6 vs. 1.8%, p < 0,001), with a lower mortality when AWS was secondary diagnosis (1.2 vs. 4.2%, p < 0.005). In multivariant analysis were associated with more mortality age (OR 1.03), hepatic cirrhosis (OR 3.4), bacteriemia (OR 4.5) and respiratory infection (OR 3.6). CONCLUSION: Alcohol withdrawal syndrome mortality could to benefit from treatment in an Internal Medicine Service.

Epidemiología del síndrome de abstinencia alcohólica. Mortalidad y factores de mal pronóstico / Epidemiology of alcohol withdrawal syndrome. Mortality factors of poor prognostic

Introducción: El alcoholismo y la aparición del síndrome de abstinencia alcohólica (SAA) condicionan un peor pronóstico en los pacientes que lo presentan. Métodos: Se recogieron las características epidemiológicas, evolución y mortalidad de todos los casos diagnosticados de SAA en el Complexo Hospitalario de Santiago durante los años 1997 al 2002. Resultados: Se identificaron 924 casos con una mortalidad del 2,4% (1,6% en Medicina Interna). La mortalidad se asoció con mayor edad (57 años ± 15 vs. 49± 13, p < 0,005), y con los diagnósticos de cirrosis hepática (6,2 vs. 1,8%, p < 0,005), bacteriemia (10 vs. 1,8%, p < 0,001) e infección respiratoria (9,6 vs. 1,8%, p < 0,001), con una mortalidad menor cuando el SAA fue diagnóstico secundario (1,2 vs. 4,2%, p < 0,005). En el análisis multivariante se asociaron a mayor mortalidad la edad (OR 1,03), la cirrosis hepática (OR 3,4), la bacteriemia (OR 4,5) y la infección respiratoria (OR 3,6). Conclusión: La mortalidad asociada al síndrome de abstinencia podría beneficiarse de la centralización del tratamiento en el Servicio de Medicina Interna

Introduction: Patients with alcoholism and alcohol withdrawal syndrome (AWS) have a worse prognostic. Methods: We have performed a retrospective analysis of the hospital discharges in with diagnosis include AWS from 1 of January of 1997 to the 31 of December of 2002. Results: We identified 924 hospital stays with 2.4% of mortality (1.6% in Internal Medicine). Mortality is associated with greater age (57 years ±15 vs. 49± 13, p < 0.005), with the diagnostic of hepatic cirrhosis (6.2 vs. 1.8%, p < 0.005), bacteraemia (10 vs. 1.8%, p < 0.001) and respiratory infection (9.6 vs. 1.8%, p < 0,001), with a lower mortality when AWS was secondary diagnosis (1.2 vs. 4.2%, p < 0.005). In multivariant analysis were associated with more mortality age (OR 1.03), hepatic cirrhosis (OR 3.4), bacteriemia (OR 4.5) and respiratory infection (OR 3.6). Conclusion: Alcohol withdrawal syndrome mortality could to benefit from treatment in an Internal Medicine Service

Disnea aguda y TAC helicoidal torácico / Acute dyspnea and thoracic helical CT

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