[Characteristics of acute pyelonephritis at a short-stay medical unit]. / Características de la pielonefritis aguda en una unidad de corta estancia.

OBJECTIVES: To analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. MATERIAL AND METHOD. A retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. RESULTS: 208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7+/-1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to cotrimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. CONCLUSIONS: Acute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications.

[Oral anticoagulation excess: analysis from an emergency department]. / Exceso de anticoagulación oral: análisis desde un servicio de Urgencias.

OBJECTIVES: To analyze the environmental factors associated to anticoagulation excess in adult patients who come to an emergency department of a tertiary hospital. To describe the characteristics of anticoagulant therapy, their diseases and associated drugs, clinical presentation and treatment received. METHODS: Prospective study of randomized patients conducted in the Emergency Department of Hospital Gregorio Marañón in Madrid during 6 months. Those patients whose INR was greater than or equal to 6 due to having taken acenocoumarol were included. Variables collected for all of them were: age, gender, INR when coming to the emergency department, anticoagulation indication, its beginning and duration, physician anticoagulation controlling, time since previous INR control, last INR assessment, treatment changes. Other variables were: comorbidity, associated medications, dietary changes, presence of bleeding, its location and treatment received. The statistical analysis was performed with the SPSS program (vs 13). RESULTS: A total of 49 adult patients, 63.3% female, whose average age was 77.9 (48-94) were included. Mean INR value was 8.2 (6-12). Indication due to atrial fibrillation was found in 71.4%. The most common associated diseases were heart failure and chronic nephropathy (18.4% and 16.3%, respectively). Twelve patients (24.5%) had consumed paracetamol recently. Active hemorrhage occurred in 34.7% of cases. CONCLUSIONS: Anticoagulation excess is a common problem in people over 70, where comorbidity and medications may determine the INR value. Bleeding risk is significant so that this group of patients should be closely monitored.

[Cardiac tamponade in a woman with primary hypothyroidism]. / Taponamiento cardiaco en una mujer con hipotiroidismo primario.

Pericardial effusion is not infrequent as a manifestation of hypothyroidism, however, cardiac tamponade is exceptional in these patients. We report a case of a female patient with cardiac tamponade that in the forward workshop was diagnosed of primary hypothyroidism. A brief presentation of clinical history is reported. The literature's review emphasizes the rarity of this case, the importance of the knowledge of triggering factors to establish a precious diagnosis and satisfactory clinical evolution with hormonal treatment without recurrences of the cardiac tamponade after pericardiocentesis is performed, although the resolution of the pericardial effusion is usually slow.

[Charcot-Marie-Tooth disease, dilated myocardiopathy and cardiac conduction disorders]. / Enfermedad de Charcot-Marie-Tooth, miocardiopatía dilatada y trastornos de la conducción cardiaca.

We describe the case of two brothers with Charcot-Marie-Tooth disease, dilated cardiomyopathy and disorders in the cardiac conduction. We review the literature in order to find physiological grounds for these associations. Despite the absence of consolidated data on this question, the genetic grounds could play some role here. In this sense, our cases contribute with the novelty that the disease affects two brothers. This has never been described before and could contribute, along with future observations, to clarify some etiopathogenic aspects of the disease.