[Descemet's stripping automated endothelial keratoplasty (DEAEK). Systematic review of clinical-effectiveness and safety]. / Queratoplastia endotelial automatizada con pelado de membrana de Descemet (DSAEK). Revisión sistemática sobre efectividad y seguridad.

OBJECTIVE: To conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. METHODS: Comprehensive literature search conducted in the main biomedical databases from January-May 2012. RESULTS: Following a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6 to 0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5-23%), primary failure (0-12%) and endothelial rejection (0.8-8.5%). CONCLUSIONS: In Fuchs' dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited.

[Do we define the COPD correctly?]. / Definimos correctamente la EPOC?

Chronic obstructive pulmonary disease (COPD) is a very common disease which prevalence is increasing and in a nearly future it will represent a socio-sanitary problem. This article s objective is to make a reflexion about the concept COPD, for the physicians contribute to their divulgation to the population and very specially to help to the tobacco desertion. Besides we want to reveal that the term has been well-finished due to the advance in the knowledge of aetiology, physiopathology, and radiology techniques. Although, we think that the acronym still includes entities with a very different features. We hope to clarify this concept in the future, establishing different phenotypes and mainly with molecular biology.

[Epidemiological events related to decompensated heart failure]. / Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca.

OBJECTIVE: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. METHODS: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. RESULTS: 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. CONCLUSIONS: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.

[Which patients with heart failure should be offered cardiac resynchronization?]. / A qué pacientes con insuficiencia cardíaca debemos ofertar la resincronización cardíaca?

Chronic heart failure is a very prevalent disease in developed countries. In recent decades, very important advances in drug therapy have occurred. However, mortality is still very high. One third of patients with a low ejection fraction and New York Heart Association (NYHA) functional class IIII-IV have a wide QRS. This means that there is often resynchronization of contraction and higher mortality. In order to improve the prognosis, the therapy based on cardiac resynchronization device has bee4n shown to be a complementary medical treatment and has contributed to clinical, hemodynamic and mortality improvements. In this article, we aim to show the results of clinical trials and recommendations of the main guidelines regarding this therapy.

[Loiasis. Approach to a form of ocular parasitosis]. / Loiasis. Aproximación a una forma de parasitosis ocular.

CASE REPORT: We present the case of a man from Cameroon who was referred because of the presence of a worm in both eyes, intermittently, over a five-year period. Slit-lamp examination revealed a creeping worm under the conjunctiva. Its surgical removal enabled microbiologic confirmation of a mature form of Loa-Loa. DISCUSSION: Loiasis is a parasitic disease endemic in Africa. Because of the increase of African emigration to Spain, the possibility of this condition must be considered in Spain.

[Which is the role of the angiotensin II receptor blockers (ARBs) for the treatment of heart failure? Do we work based on evidence/recommendations or pharmaceutical industry pressure?]. / ¿Qué papel ocupan los ARA-II en el tratamiento de la insuficiencia cardiaca? ¿Actuamos por evidencias/recomendaciones o por la presión de la industria farmacéutica?

Chronic heart failure (CHF) represents the first cause of hospitalization in persons older than 6o years in our environment. Beside its incidence and prevalence is increasing although new therapeutic treatments. We think the recommendations of the guidelines of clinical practise are an important instrument to make decisions, although sometimes it is used a numeric language little clear. We do not have either to forget that sometimes patients selected for the clinical trials aren t really representative. Finally to add that pharmaceutical industry spends a lot of money on investigating active basics, but as company itself is needs to obtain benefits. With all of this, in this article we try to study the role of angiotensin II receptor blockers (ARBs) occupy in the medic strategy for the planification of a patient s treatment with chronic heart failure.

[Epidemiology of heart failure. Ratio of epidemic]. / Epidemiología de la insuficiencia cardiaca. Proporciones de epidemia.

The Heart Failure is a complex sindrom with a high prevalence in the population, being about 10% in older than 70 years and it is continuosly increasing . Its incidence in persons older than 65 years is about 1% per year. In developed countries it is the first cause of hospitalitation in older than 65 years, supposing the 5% of total admissions and it is increasing every year. The most of authors recognise that the numbers reach values of epidemic, although it is true that it is difficult to determine and cuantify due to its complexity. Although the supervivence has improved in last years, it continues being in a bad pronostic with a mortality about 50% after 5 years approximately of the diagnostic . In order to its high prevalence and its high rate of admissions-readmissions it supposes a problem of public health due to high assistance work. Globally it is estimated that the direct costs of heart failure suppose 1-2 % of healthy cost of developed countries.

[Paraneoplastic limbic encephalitis and epidermoid carcinoma of the pyriform]. / Encefalitis límbica paraneoplásica y carcinoma epidermoide del seno piriforme.

Paraneoplastic limbic encephalitis is a syndrome characterised by behaviour changes, short-term memory loss and seizures. We report on a case of a 62-year-old man, ex-smoker who was admitted to the Intensive Care Unit with seizures, and who had previously experienced behaviour changes. Tests revealed nothing notable, except for the CSF examination which revealed elevated protein and MRI findings indicating temporal lobe abnormalities. Once other diagnoses had been ruled out, neoplasm screening was initiated. Conventional imaging failed to identify the tumour. Antineuronal anti-Hu antibodies were negative. Finally, fluorodeoxyglucose (FDG) whole body -PET imaging was carried out revealing a pathologically increased glucose metabolism at the pharynx-larynx level. The biopsy showed an epidermoid carcinoma of the pyriform sinus. To the best of our knowledge, this is the first reported case of an epidermoid carcinoma of the pyriform sinus associated with paraneoplastic limbic encephalitis.

[COPD, a public health problem]. / Enfermedad pulmonar obstructiva crónica, un problema de salud pública.

The fundamental etiologic factor of COPD is tobacco. This has a 9% prevalence in Spain and although this rate is underestimated according to the last studies, COPD generates about 39,000 hospital admissions per year. It has a re-admission rate between 12% and 32%, infections being the fundamental cause. The average care cost per patient from its diagnostic to death is 27,500 euro and we should add a high percentage of employee absenteeism. Due to its chronic aspect, high health care cost and possible improvement of the quality of life of patient, the solution to the problem needs to have a more active involvement of the doctor who attends these patients.

Hospital at home for acute respiratory patients.

BACKGROUND: The issue of "hospital at home" (HAH) for acute respiratory patients is one that is still being debated, partly because economic, cultural and health service differences between locations imply that HAH schemes need to be tailored to local situations. The aim of the present study was to analyze the feasibility and effectiveness of HAH for patients with acute respiratory disease at our institution. METHODS: Of all the patients admitted to our institution via the emergency department during a 34-day subject enrollment period, 25 with diagnoses of respiratory infection, pneumonia, pulmonary insufficiency or exacerbated chronic obstructive pulmonary disease who were living within 25 km of our center and who were willing to receive HAH care were assigned to HAH. Fifty sex-matched controls with the same diagnoses were given conventional hospital care (CHC) as inpatients. The dependent variables evaluated included time to discharge, readmissions within 3 months and deaths within 3 months. RESULTS: There were no significant differences between the HAH and CHC groups with regard to age, diagnoses, physical and analytical findings, or co-morbidity, or with regard to deaths (HAH 16%, CHC 10%) or readmissions (HAH 17%, CHC 24%). Time to final discharge was significantly shorter for HAH patients (7 days) than for CHC patients (12 days). Some 95% of the HAH patients were satisfied and would choose HAH again. CONCLUSIONS: HAH seems feasible for appropriately selected acute respiratory disease patients presenting in our emergency department. It frees hospital beds for other patients, its readmission and mortality rates are no higher than for conventional hospitalization, and, in general, it is favorably evaluated by patients.

[Controversies in infective endocarditis]. / Controversias en endocarditis infecciosas.

The infective endocarditis is defined mainly as the infection of the internal surface of the heart, affecting to the cardiac valves although it can also do it to the septos, the tendinosas cords or endocardio mural. Around the origin, the diagnosis and the treatment of the disease, a considerable controversy has taken place. In this sense, basic criteria exist that they define to the infective endocarditis; however, particular situations are appraised in which the meticulous study is essential from the patient, doing special reference to the origin agents and, more in particular, to the fungal endocarditis.

[A rare presentation of tuberculosis. Miliary tuberculosis in a immunocompetent patient]. / Rara presentación de tuberculosis. Afectacón miliar en paciente inmunocompetente.

Currently, miliary TB has a higher incidence among the elderly and immunodepressed patients, and exceptionally in young adults. A case of miliary tuberculosis was diagnosed in a young immunocompetent patient without using invasive techniques. The clinical and diagnostic implications will be discussed.

[Factor analysis of the health related quality of life of patients with stable chronic obstructive pulmonary disease]. / Análisis factorial de la calidad de vida relacionada con la salud de pacientes con enfermedad pulmonar obstructiva crónica estable.

OBJECTIVE: To identify factors associated with the health-related quality of life (HRQL) perceived by patients with stable chronic obstructive pulmonary disease (COPD). DESIGN: Prospective cohort study. SUBJECTS: Patients with stable COPD (n = 204, alpha = 0.05, d = 6.9%). MEASURES AND INTERVENTIONS: For every patient we recorded sociodemographic and treatment data,severity of dyspnea, and the results of gasometry and lung function and stress testing, as well as responses to the Chronic Respiratory Disease Questionnaire (CRDQ). After studying the associations between variables we carried out factor analysis of those that were significantly related to HRQL. RESULTS: Men made up 91.7% of the cohort. The mean age (standard deviation)was 71 (9), FEV1% was 45 (16) and FEV1/FVCwas 48 (10). HRQL was statically related to age, weight, body mass index (BMI), economic status, educational status, chronic treatment with oral corticosteroids, ODCA, PaO2, oxygen saturation, alveolar-arterial oxygen gradient, absolute FEV1, FEV1%, post-bronchodilatation FEV1, absolute FVC, FVC%, distance walked in six minutes, oxygen saturation before the walking test and lowest oxygen saturation during the test,difference in dyspnea before and after the test measured on a visual analog scale. Factor analysis reduced the main variables to six, which explained 74.6% of the variance, as follows: Factor1 PaO2, oxygen saturation and alveolar-arterial oxygen gradient (33.7%); Factor 2 absolute FEV1,FEV1%, FEV1 after bronchodilatation, absolute FVC and FVC% (11.9%); Factor 3 eight and BMI (8.8%); Factor 4 age, severity of dyspnea and walking test distance (8.4%);Factor 5: corticosteroid dependence and domiciliary oxygen therapy(6.3%); and Factor 6: economic and educational status (5.5%). CONCLUSION: HRQL in stable COPD patients is partially related to severity of respiratory insufficiency, airflow obstruction, nutritional status, exercise capacity, severity of disease, and socioeconomic status.