Cribado nutricional con mini nutritional assessment (MNA) en medicina interna. Ventajas e inconvenientes / Mini nutritional assessment (MNA) as nutrition screening tool in internal medicine. Advantages and disadvantages

Objetivo. Evaluar la situación nutricional del paciente anciano hospitalizado mediante el Mini Nutritional Assessment (MNA), su relación con la prolongación de estancias y mortalidad, la incidencia de desnutrición durante el ingreso y evaluar la aplicabilidad del MNA en un área de hospitalización de agudos de Medicina Interna. Material y métodos. Estudio prospectivo de la situación nutricional de pacientes de 65 años o más ingresados, de forma consecutiva, en un servicio de Medicina Interna. Son incluidos 106 pacientes. Las variables a estudio son la valoración nutricional (MNA, colesterol, linfocitos, albúmina, peso, talla, índice de masa corporal, plicometría), la evolución del episodio, edad, institucionalización, dependencia y comorbilidad. Resultados. Se han estudiado 106 pacientes, edad media de 81±7 años, índice de Charlson 2,3±1,9 e índice de Barthel 74,9±30,8. El peso medio era de 64,5±10,6kg, índice masa corporal (IMC) de 26±3,9, y la pérdida de peso en los últimos 3 meses de 1,17±2,92kg. La estancia media fue de 11,1±9,8 días y la mortalidad del 5,7%. La prevalencia de malnutrición fue del 4,7% y de riesgo nutricional del 36,8%. Los pacientes desnutridos tuvieron una estancia más prolongada, más edad, comorbilidad y dependencia; no existen diferencias concluyentes en la mortalidad. La incidencia de desnutrición durante el ingreso osciló entre 2,43 y 15,68%. Conclusiones. La desnutrición origina un aumento de la morbimortalidad y del uso de recursos. Los servicios asistenciales responsables del paciente deben realizar una valoración nutricional al ingreso y repetirla a lo largo de la hospitalización, empleando herramientas de cribado sencillas que incorporen un plan de intervención nutricional explícito(AU)

Objective. To evaluate the nutritional status of the elderly hospitalized patient with the Mini Nutritional Assessment (MNA), its relationship with length of hospital stay and mortality, the incidence of malnutrition during hospitalization and to evaluate the applicability of MNA in an Internal Medicine Department of an acute care hospital. Material and methods. A prospective study on the nutritional status of patients of 65 years or older admitted to hospital in an Internal Medicine Department was performed in 106 consecutive patients. In all patients a MNA test, an anthropometric (weight, height, body mass index, skinfold), and biochemical (cholesterol, lymphocytes, albumin) evaluation were performed; outcome, age, institutionalization, Charlson index and Barthel index were recorded. Results. Mean age of the patients was 81±7 years, Charlson index 2.3±1.9 and Barthel index 74.9±30.8. Mean weight was 64.5±10.6kg, BMI 26±3.9, and weight loss in the previous 3 months 1.17±2.92kg. Mean length of hospital stay was 11.1±9.8, and mortality was 5.7%. Prevalence of malnutrition, assessed by MNA, was 4.7%, and 36.8% of the patients were at risk of malnutrition. Malnourished patients have a longer length of hospital stay, higher Barthel and Charlson indexes. There are no conclusive differences in mortality. Incidence of malnutrition during hospitalization was between 2.43 and 15.68%. Conclusions. Malnutrition increases length of hospital stay, rate of complications and costs. The clinicians responsible for the patient should perform nutrition evaluation at hospital admission and repeat it during the hospitalization, using simple screening tools that incorporate an explicit nutrition intervention plan(AU)

[Mini nutritional assessment (MNA) as nutrition screening tool in internal medicine. Advantages and disadvantages]. / Cribado nutricional con mini nutritional assessment (MNA) en medicina interna. Ventajas e inconvenientes.

OBJECTIVE: To evaluate the nutritional status of the elderly hospitalized patient with the Mini Nutritional Assessment (MNA), its relationship with length of hospital stay and mortality, the incidence of malnutrition during hospitalization and to evaluate the applicability of MNA in an Internal Medicine Department of an acute care hospital. MATERIAL AND METHODS: A prospective study on the nutritional status of patients of 65 years or older admitted to hospital in an Internal Medicine Department was performed in 106 consecutive patients. In all patients a MNA test, an anthropometric (weight, height, body mass index, skinfold), and biochemical (cholesterol, lymphocytes, albumin) evaluation were performed; outcome, age, institutionalization, Charlson index and Barthel index were recorded. RESULTS: Mean age of the patients was 81±7 years, Charlson index 2.3±1.9 and Barthel index 74.9±30.8. Mean weight was 64.5±10.6kg, BMI 26±3.9, and weight loss in the previous 3 months 1.17±2.92kg. Mean length of hospital stay was 11.1±9.8, and mortality was 5.7%. Prevalence of malnutrition, assessed by MNA, was 4.7%, and 36.8% of the patients were at risk of malnutrition. Malnourished patients have a longer length of hospital stay, higher Barthel and Charlson indexes. There are no conclusive differences in mortality. Incidence of malnutrition during hospitalization was between 2.43 and 15.68%. CONCLUSIONS: Malnutrition increases length of hospital stay, rate of complications and costs. The clinicians responsible for the patient should perform nutrition evaluation at hospital admission and repeat it during the hospitalization, using simple screening tools that incorporate an explicit nutrition intervention plan.

[Study on the immediate care clinics of the Internal Medicine Department (University Clinic Hospital of Valladolid)]. / Evaluación de las consultas de atención inmediata en Medicina Interna (Hospital Clínico Universitario de Valladolid).

BACKGROUND: Several studies have found a high percentage of inadequate admissions to Internal Medicine Departments. In order to try to alleviate this situation, the Immediate Care Clinics of the Internal Medicine Department (ICCIMD) was created, to study those patients who are suspected of having a serious disease, and whose physical condition allows them to undergo an out-patient study the day after having visited the Emergency Department. The tests requested will take precedence over the rest of the consultations. METHODS: Descriptive, retrospective study, through the review of the clinical records of the patients who came to the ICCIMD during the first two years. RESULTS: Our service admitted 726 people in the ACCIMD, 52.2 % males, average age of 54.12 years old. A total of 18.6 % of the patients required hospital admission; this admission being carried out at the first medical examination in 66.7% of the cases. In most cases, it can be related with shortening a study that would have lasted longer. In spite of this, we consider that 1.4 daily admissions have been avoided. Mean time devoted to this study was about 33.20 days, much greater than that expected, because of the high prevalence of non-specific disease and hospital organization deficit. It was decided to study 76.6% of the patients sent, their diagnosis being achieved in 63.3% of the total number of patients. Nevertheless, the ICCIMD was inadequate, as hospital admission was required or the patient was sent to other specialities in the 27.3% of the cases. CONCLUSIONS: We think that the ACCIMD can be useful to improve efficiency of Internal Medicine Department, although, to do so, the significant problems found must be solved.

Evaluación de las consultas de atención inmediata en Medicina Interna (Hospital Clínico Universitario de Valladolid) / Study on the inmediate care clinics of the Internal Medicine Department (Universitary Clinic Hospital of Valladolid)

Introducción. Diversos estudios han encontrado un alto porcentaje de ingresos inadecuados en los servicios de Medicina Interna. Para paliar esta situación se creó la Consulta de Atención Inmediata en Medicina Interna (CAIMI), en la que se estudia a pacientes con sospecha de patología grave, pero que su estado físico les permita un estudio ambulatorio al día siguiente de haber ido a Urgencias. Las pruebas solicitadas tendrían prioridad sobre las del resto de consultas. Métodos. Estudio descriptivo, retrospectivo, mediante la revisión de las historias clínicas de los pacientes atendidos en la CAIMI durante los dos primeros años. Resultados. Nuestro servicio atendió en la CAIMI a 726 personas (el 52,2% varones) con una edad media de 54,12 años. El 18,6% de los pacientes atendidos precisó el ingreso; el 66,7% de ellos desde la primera consulta. En la mayoría de los casos parece relacionarse con el hecho de acortar un estudio que se prevé largo. A pesar de ello estimamos que se han evitado 1,4 ingresos al día. El tiempo medio de estudio empleado fue de 33,20 días, muy superior al esperado, debido a la alta prevalencia de patología inespecífica valorada y déficit de organización hospitalaria. Se decidió estudiar al 76,6% de los pacientes enviados, lográndose el diagnóstico en el 63,3% del total de pacientes. Sin embargo, la CAIMI fue insuficiente al precisar el ingreso o la derivación a otras especialidades en el 27,3% de los casos. Conclusiones. Creemos que la CAIMI puede ser útil para mejorar la eficiencia de los servicios de Medicina Interna, aunque para ello es necesario solucionar los importantes déficit encontrados

Background. Several studies have found a high percentage of inadequate admissions to Internal Medicine Departments. In order to try to alleviate this situation, the Immediate Care Clinics of the Internal Medicine Department (ICCIMD) was created, to study those patients who are suspected of having a serious disease, and whose physical condition allows them to undergo an out-patient study the day after having visited the Emergency Department. The tests requested will take precedence over the rest of the consultations. Methods. Descriptive, retrospective study, through the review of the clinical records of the patients who came to the ICCIMD during the first two years. Results. Our service admitted 726 people in the ACCIMD, 52.2 % males, average age of 54.12 years old. A total of 18.6 % of the patients required hospital admission; this admission being carried out at the first medical examination in 66.7% of the cases. In most cases, it can be related with shortening a study that would have lasted longer. In spite of this, we consider that 1.4 daily admissions have been avoided. Mean time devoted to this study was about 33.20 days, much greater than that expected, because of the high prevalence of non-specific disease and hospital organization deficit. It was decided to study 76.6% of the patients sent, their diagnosis being achieved in 63.3% of the total number of patients. Nevertheless, the ICCIMD was inadequate, as hospital admission was required or the patient was sent to other specialities in the 27.3% of the cases. Conclusions. We think that the ACCIMD can be useful to improve efficiency of Internal Medicine Department, although, to do so, the significant problems found must be solved

Utilización de marcadores tumorales en Atención Primaria / Clinical use of tumour markers in Primary Health Care

El cáncer en España, como en el resto de países desarrollados, representa la segunda causa de muerte después de las enfermedades cardiovasculares, y la primera en cuanto a Años Potenciales de Vida Perdidos. Los Marcadores Tumorales (MT) se presentan como una herramienta útil en Atención Primaria a la hora de buscar soluciones en los tres escalones de la prevención y de buscar métodos para detectar precozmente la enfermedad, cuantificar su grado de control y seguimiento y predecir sus recidivas, si bien su efectividad y eficiencia en la práctica clínica diaria no está aún claramente establecida. A lo largo de este trabajo se revisa críticamente la evidencia existente en cuanto a las recomendaciones para el uso de los MT en el cribado, diagnóstico precoz y seguimiento de cuatro de los tumores más relevantes en nuestra práctica diaria (colon, ovario, mama y próstata), encontrando que no existe evidencia suficiente para apoyar su uso rutinario en el cribado poblacional de los mismos, aunque sí para su uso en el seguimiento y control de la respuesta al tratamiento de alguno de ellos (AU)

[Hyperthyroidism, jaundice, and pulmonary hypertension]. / Hipertiroidismo, ictericia e hipertensión pulmonar.

Although the most frequent cause associated to the alteration of hepatic function tests that some hyperthyroid patients show is concomitant heart insufficiency, some cases without heart insufficiency and normalisation of hepatic tests after normalising the thyroid function have been described. There is also some evidence of hyperthyroid patients with pulmonary arterial hypertension, with no clear cause, coming back later to normal figures or substantially descending, after the treatment for hyperthyroidism. We show the concrete case of a 66 years woman, who has a due to toxic multinodular goiter hyperthyroidism with jaundice and serious pulmonary hypertension associated, unexplainable by further causes, both regressing with normalisation of thyroid function with no evidence of associated autoimmune pathology. Following, the physiopathology explanations about this unusual association found in literature, are commented.

Hipertiroidismo, ictericia e hipertensión pulmonar / Hyperthyroidism, jaundice and pulmonary hypertension

Aunque la causa más frecuentemente asociada a la alteración de las pruebas de función hepática que presentan algunos pacientes hipertiroideos es la insuficiencia cardiaca concomitante, se han descrito casos sin insuficiencia cardiaca, con normalización de las pruebas hepáticas tras normalizar la función tiroidea.También hay evidencia de enfermos hipertiroideos con hipertensión arterial pulmonar sin causa clara, regresando ésta a cifras normales, o descendiendo substancialmente, tras el tratamiento del hipertiroidismo. Nosotros presentamos el caso de una mujer de 66 años con un hipertiroidismo debido a un bocio tóxico multinodular, con ictericia e hipertensión arterial pulmonar severa asociadas y no explicables por otras causas, regresando ambas con la normalización de la función tiroidea y sin evidencia de patología autoinmune asociada.Posteriormente se comentan las explicaciones fisiopatológicas encontradas en la literatura sobre esta inusual asociación. (AU)

Mieloma múltiple IgG lambda: derrame pleural mielomatoso, una rara forma de presentación / Multiple myeloma lambda IgG: myelomatous pleural effusion, an unusual presentation

No disponible

[Short-stay units depending on Internal Medicine]. / Unidad de corta estancia dependiente de Medicina Interna.

BACKGROUND: Wetry to establish the utility that a Short Stay Unit depending on Internal Medicine has for a third level hospital. This unit manages the patients under the "appropriate stay" concept. METHODS: Several clinical and epidemic variables and sanitary indicators were studied in 867 patients. Cost was measured as the origin by average stays, explorations and readmission. Effectiveness was considered as the percentage of discharges that stay in the hospital for three days or less. RESULTS: The average age of the patients was 65.05 years. 55% were males. 82.24% had any previous disease. The most common diagnosis (ICD-9) were respiratory diseases, nervous system diseases and digestive diseases. The average stay of the patients was 57 hours, 2,259 explorations were ordered, it supposes an average of 0.328 urgent explorations and 2,276 UCE explorations. 310 explorations were no received when the patient was sent home. 36.56% of the patients required no explorations. 62.4% of the patients were sent home. Explorations not received had a bad influence in the average stay and in the discharges. Readmissions were 9.36%. CONCLUSIONS: We got hay 62.4% of the patients had a stay of 2,375 days in the hospital, With a reasonably low cost in readmissions and explorations. However it wasn't possible to establish which patient coming to the Emergency Service is appropriate for this Short Stay Unit.

Unidad de corta estancia dependiente de Medicina Interna / Short stay unit depending on internal medicine

Fundamento: Establecer la utilidad que, para el hospital de tercer nivel, tiene una Unidad de Corta Estancia dependiente de Medicina Interna, cuyo trabajo se centra en el manejo de los pacientes bajo el concepto de "estancia adecuada". Métodos: Se estudian variables epidemiológicas, clínicas, e indicadores sanitarios de 867 pacientes. Con la información obtenida se evalúan las estancias medias, las pruebas complementarias y los reingresos. Así mismo, el porcentaje de altas domiciliarias con una estancia menor o igual a tres días. Resultados: La media de edad de los 867 pacientes es de 65,05 años. El 55% son varones. Un 82,24% padece algún antecedente médico. Los diagnósticos al alta más frecuentes (CIE-9) son las Enfermedades Respiratorias, seguidas de las del Sistema Nervioso y Digestivas. La estancia media en la Unidad ha sido de 57 horas. Se han solicitado 2.259 estudios complementarios, con un promedio de pruebas urgentes y de UCE de 0,328 y 2,276 respectivamente. De ellas hay 310 que, en el momento del alta, no se han realizado o recibido. El 36,56% de los pacientes no tienen pruebas pedidas en la Unidad. Respecto al destino de alta, el 62,4 porciento fueron altas hacia el domicilio. Las pruebas no disponibles influyeron negativamente en la estancia media y en las altas dadas hacia el domicilio. Hubo un 9,36porciento de reingresos. Conclusiones: Se ha logrado que el 62,4% de los pacientes tengan una estancia hospitalaria de unos 2.375 días, con un porcentaje de reingresos y promedio de pruebas complementarias razonablemente limitado. Sin embargo, no ha sido posible establecer, desde el Servicio de Urgencias, el paciente "tipo" candidato a la corta estancia (AU)

[Experimental renal insufficiency in rabbits produced by the intrarenal injection of cyanoacrylic ester]. / Insuficiencia renal experimental en conejos por inyección intrarrenal de ester cianoacrílico.

Through a percutaneous intrarenal injection of 2 ml cyanoacrylic ester to each kidney, acute renal failure was induced in 10 experimental rabbits. Seven of the animals died as a consequence of uremia before a period of 64 hours. The other three remained alive for 96 hours although suffering from stable renal failure. Cyanoacrylic ester solidifies immediately after injection, leading to a hardened body which fills the renal pelvis, ureters and also the renal vessels. Each injection induces hydronephrosis and necrotic-hemorrhagic lesions, and infarcts in the case of vascular injection. With this simple technique immediate acute renal failure can be obtained experimentally without causing trauma or involving extrarenal structures.