[Myocardial infarct in the geriatric patient: the short- and mid-term prognostic factors]. / El infarto de miocardio en el paciente geriátrico: factores pronósticos a corto y medio plazo.

The purpose of this study was to investigate the clinical features and the prognostic factors related to early and late mortality in the acute myocardial infarction (AMI) in the geriatric population. We have studied 208 consecutive patients with AMI admitted to the Coronary Care Unit at the Hospital General de Asturias. Two groups were selected: group A included 102 patients older than 65 years; and 106 were younger (group B). In the group A was found a significantly lower percentage of males (52.9% vs 89.6%; p less than 0.0001) and smokers (45.1% vs 89.6%; p less than 0.0001); and older patients showed a greater incidence of diabetes mellitus (30.7% vs 16%; p less than 0.01). In the geriatric group, the clinical course of AMI is characterized by a greater incidence of heart failure (50% vs 29.2%; p less than 0.002) and cardiogenic shock (22.5% vs 7.5%; p = 0.002). Early mortality (first month) was significantly higher in elderly patients (36.3% vs 7.5%; p less than 0.001); and this increased mortality rate is partially related to an increased incidence of heart pump failure, despite having a smaller enzymatic infarct size by CPK peak (1,062 +/- 1,017 U/l vs 1,579 +/- 1,428 U/l; p less than 0.005). The multivariate analysis by stepwise logistic regression, selected diabetes mellitus, heart failure and peri-infarct bundle branch blocks as the only independent predictive variables for the early mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Myocardial infarct in diabetes mellitus: short- and long-term prognostic factors]. / Infarto del miocardio en la diabetes mellitus: factores pronósticos a corto y largo plazo.

To determine the evolution of acute myocardial infarction in patients with diabetes we study 207 consecutive patients with myocardial infarction. Using WHO's criteria 23% of our cases were diagnosed of diabetes mellitus. Diabetic patients were older than non diabetic (67.9 +/- 10 years vs. 62.4 +/- 11 years, p less than 0.05) and had a higher ratio of females (52% vs. 21%, p less than 0.001). Cigarette smoking was infrequent in diabetic population. Incidence of other risk factors was comparable. Despite an increased proportion on no q-wave myocardial infarction in the diabetic patients (12.5% vs. 6.9%, p NS), the site of infarction was similar into the two groups. Acute phase mortality was higher in the diabetic group (37.5% vs. 16.3%, p less than 0.001). This increased mortality is, partially, related to an increased incidence of pump failure, but a multivariate analysis using stepwise logistic regression, selected diabetes as an independent predictor of prognosis. Survivors were followed for 41 +/- 20 months; diabetic patients showed a poor prognosis with a higher incidence of congestive heart failure (42.8% vs. 13.7%, p less than 0.01), reinfarction (16.6% vs. 8.5%) and death. Cox proportional hazard model selected diabetes as an independent predictor of survival. We conclude that patients with diabetes mellitus constitute a subgroup into the myocardial infarction population; this subgroup had greater mortality than non diabetic patients in relation to increased incidence of pump failure, but multivariate analysis indicates that other factors not considered in the present study may play a role in their poor prognosis.

[Smoking among health professionals at hospitals in Asturias]. / Estudio del tabaquismo en profesionales sanitarios del medio hospitalario de Asturias.

The smoking habits of 454 doctors and 332 nursing staff members of 11 hospitals from Asturias, Spain, were studied. The mean age of the physicians was 35 +/- 8.6 years (22 to 68 years) and of the nurses was 31.8 +/- 7.3 years (19 to 60 years). 54% of doctors and 57.2% of the nurses were found to have a smoking habit (daily and occasional); and was similar in both sexes. In this survey, the 54.1% of the cardiologists were smokers (daily smokers: 39.6%; occasional smokers: 14.6%; ex smokers: 25%; non smokers: 20.8%). In conclusion, the example of the health professionals in the hospitals from Asturias is negative due to higher rate of smokers. The health professionals should be involved in an active and exemplary way against this habit.

[Endocarditis caused by Coxiella burnetii in aortic prosthesis. Presentation of a case with a fatal course]. / Endocarditis por Coxiella burnetii sobre prótesis aórtica. Presentación de un caso de evolución fatal.

A case of endocarditis caused by Coxiella burnetii in a patient with an aortic Starr-Edwards prosthesis is described. The diagnosis was made by detecting high titres of antibody against Coxiella burnetii phase I antigens. After 15 weeks of chemotherapy with tetracycline and cotrimoxazole, aortic prosthetic valve replacement was carried out because of haemodynamic deterioration and he died 4 days later. The histologic picture of the excised valve was consistent with endocarditis. Coxiella burnetii should be considered in the differential diagnosis of culture-negative endocarditis in our country, especially when the patient has not receiving antibiotic treatment in the last 2 weeks.

Iron toxicity studies of quelamycin.

A previous phase I study demonstrated excessive generalized toxicity (20 of 21 patients) and cardiotoxicity (eight of 21 patients) of single-day intermittent quelamycin (NSC-267703) treatment, and a modified schedule was recommended to overcome this acute toxicity. In the present study, 40 mg/m2 of quelamycin was administered iv on 2 or 3 consecutive days. This 2- or 3-day course was associated with a decrease in the incidence of general symptoms (five of nine patients) and a decrease in cardiotoxicity (none of nine patients). In addition, patients receiving multiple courses of quelamycin were evaluated. Clinical and pathologic findings supported the diagnosis of early hemochromatosis. In conclusion, quelaymcin administration was associated with acute and chronic iron-overloading toxicity. Acute iron toxicity was prevented by the administration of quelamycin at a dose of 40 mg/m2 iv on 3 consecutive days. On the other hand, hemochromatosis was an unexpected finding which requires further investigations before this drug is acceptable for broader studies.