Role of Early Assesment of Diuresis and Natriuresis in Detecting In-Hospital Diuretic Resistance in Acute Heart Failure.

Background and Purpose: European Guidelines recommend early evaluation of diuresis and natriuresis after the first administration of diuretic to identify patients with insufficient diuretic response during acute heart failure. The aim of this work is to evaluate the prevalence and characteristics of patients with insufficient diuretic response according to this new algorithm. Methods: Prospective observational single centre study of consecutive patients with acute heart failure and congestive signs. Clinical evaluation, echocardiography and blood tests were performed. Diuretic naïve patients received 40 mg of intravenous furosemide. Patients on an oupatient diuretic regimen received 2 times the ambulatory dose. The diuresis volume was assessed 6 h after the first loop diuretic administration, and a spot urinary sample was taken after 2 h. Insufficient diuretic response was defined as natriuresis <70 mEq/L or diuresis volume <600 ml. Results: From January 2020 to December 2021, 73 patients were included (59% males, median age 76 years). Of these, 21 patients (28.8%, 95%CI 18.4; 39.2) had an insufficient diuretic response. Diuresis volume was <600 ml in 13 patients (18.1%), and 12 patients (16.4%) had urinary sodium <70 mEq/L. These patients had lower systolic blood pressure, worse glomerular filtration rate, and higher aldosterone levels. Ambulatory furosemide dose was also higher. These patients required more frequently thiazides and inotropes during admission. Conclusion: The diagnostic algorithm based on diuresis and natriuresis was able to detect up to 29% of patients with insufficient diuretic response, who showed some characteristics of more advanced disease.

Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study. / Factores asociados a la mortalidad intrahospitalaria y reingreso en una cohorte tratada con ventilación no invasiva en urgencias extrahospitalarias y hospitalarias: estudio VentilaMadrid.

OBJECTIVES: To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs). MATERIAL AND METHODS: Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission. RESULTS: A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11-5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26-5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19-33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62-6.45) and prior dependence (OR, 2.08; 95% CI, 1.02-4.22). CONCLUSION: Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52, and discontinuance of NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.

OBJETIVO: Describir las características clínicas, evolutivas y los factores pronóstico de una cohorte de pacientes tratados con ventilación no invasiva (VNI) en servicios de urgencias extrahospitalarios (SUEH) y hospitalarios (SUH). METODO: Estudio de cohortes multicéntrico, prospectivo con inclusión consecutiva de pacientes con edema agudo de pulmón o agudización de enfermedad pulmonar obstructiva crónica tratados con VNI entre noviembre 2018 y noviembre de 2020 en SUEH y SUH de la Comunidad de Madrid. Se recogieron características basales, del episodio agudo, así como variables de resultado incluyendo la mortalidad hospitalaria y el reingreso a 30 días. RESULTADOS: Se incluyeron 317 pacientes, 132 (41,6%) en SUEH y 185 (58,4%) en SUH. Hubo 47 muertes intrahospitalarias (16,3%) y 78 reingresos a los 30 días (28,8%). No hubo diferencias en la mortalidad, pero el grupo VNI-SUEH tuvo menor reingreso a 30 días. En el análisis multivariado la mortalidad intrahospitalaria se asoció con la dependencia previa (OR = 2,4; IC 95%: 1,11-5,27) y el SAPS-II bajo-moderado frente al alto-muy alto (OR = 2,69; IC 95%: 1,26-5,77). En la cohorte extrahospitalaria, la mortalidad intrahospitalaria se asoció con la retirada de la VNI en la transferencia del paciente (OR = 8,57; IC 95%: 2,19-33,60). Los reingresos a los 30 días se asociaron con inicio de VNI en el hospital (OR = 3,24; IC 95%: 2,62-6,45) y dependencia previa (OR = 2,08; IC 95%: 1,02-4,22). CONCLUSIONES: Los pacientes de ambos grupos, SUH y SUEH, tienen un perfil clínico basal similar, aunque con mayor gravedad del episodio en el grupo SUEH. No se encontraron diferencias estadísticamente significativas en la mortalidad intrahospitalaria. Se asociaron a una mayor mortalidad la dependencia, la escala SAPS-II > 52 y la retirada de la VNI. El reingreso se asoció con la dependencia y pertenecer al grupo SUH.

Derrame pleural asociado a metimazol / Pleural effusion associated to metimazol

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Lesiones ampollosas en mujer de 81 años / Blistering lesions on a 81 year old woman

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Estudio retrospectivo sobre las diferencias entre insuficiencia cardíaca sistólica y diastólica en un registro de 1.000 pacientes del hospital Puerta de Hierro-Majadahonda-Madrid. Comparación con el Registro Nacional español de Insuficiencia Cardíaca (RICA) / Retrospective study on the differences between systolic and diastolic heart failure in a registry of 1,000 patients from the Puerta de Hierro-Majadahonda Hospital, Madrid. Comparison with the Spanish National Heart Failure Registry

Resumen Objetivo: Comparar las diferencias entre insuficiencia sistólica y diastólica en pacientes ingresados en el Hospital Puerta de Hierro Majadahonda, con diagnóstico al alta de ``primer episodio de insuficiencia cardiaca''. Los resultados se cotejan con el registro nacional español de insuficiencia cardiaca (RICA). Material y método: Estudio retrospectivo que incluye a 1.000 pacientes ingresados desde octubre 2008 hasta mayo 2010. El seguimiento se realizó hasta mayo 2015. Resultados: El 70,6% procedían de Medicina Interna, con predominio del sexo femenino (62%) y una mediana de 87 años de edad. La mortalidad global fue de 69,8%, mayor en pacientes con insuficiencia cardiaca-diastólica. OR 1,03 (IC 95% 0,73-1,45). El 59% de los pacientes reingresaron al menos una vez; en su mayoría eran varones (61%) e hipertensos (89,3%). Conclusiones: Los pacientes con insuficiencia cardiaca-diastólica ingresan preferentemente en Medicina Interna (76,2%); la mayoría son mujeres hipertensas y de edad más avanzada que en el grupo de insuficiencia cardiaca-sistólica. Los resultados fueron similares a los del registro RICA, salvo mayor mortalidad y reingresos, probablemente por la edad más avanzada de los pacientes y el mayor tiempo de seguimiento.

Abstract Objective: To compare the differences between systolic and diastolic dysfunction in patients admitted to the Hospital Puerta de Hierro Majadahonda, Madrid, with a diagnosis on discharge of ``first episode of heart failure''. The results were compared with the Spanish National Heart Failure Registry (RICA). Material and method: A retrospective study that included 1,000 patients admitted from October 2008 to May 2010. The follow-up was carried out up to May 2015. Results The majority of patients were admitted to Internal Medicine, with a majority of females (62%), and with a median age of 87 years. The overall mortality was 69.8%, and was higher in patients with diastolic heart failure (OR: 1.03, 95% CI; 0.73 - 1.45). More than half of the patients (59%) were admitted at least once, with the majority being males (61%) and with hypertension (89.3%). Conclusions: Patients with diastolic heart failure were mainly admitted to Internal Medicine (76.2%). The majority were women with hypertension, and of a more advanced age than the systolic heart failure group. The results were similar to the RICA, except for the higher mortality and admissions, probably due to the more advanced age of the patients, and the longer follow-up time.

Cuerpo extraño intraocular tras un viaje a Camerún / Intraocular foreign body after a trip to Cameroon

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Patrón nodulillar pulmonar bilateral en mujer de 95 años / A 95 year old woman with bilateral nodular pulmonary pattern

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