Clinical suspicion, diagnosis and management of cardiac amyloidosis: update document and executive summary.

In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.

Responsiveness and minimal clinically important difference of the Minnesota living with heart failure questionnaire.

BACKGROUND: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most widely used health-related quality of life questionnaires for patients with heart failure (HF). The objective of the present study was to explore the responsiveness of the MLHFQ by estimating the minimal detectable change (MDC) and the minimal clinically important difference (MCID) in Spain. METHODS: Patients hospitalized for HF in the participating hospitals completed the MLHFQ at baseline and 6 months, plus anchor questions at 6 months. To study responsiveness, patients were classified as having "improved", remained "the same" or "worsened", using anchor questions. We used the standardized effect size (SES), and standardized response mean (SRM) to measure the magnitude of the changes scores and calculate the MDC and MCID. RESULTS: Overall, 1211 patients completed the baseline and follow-up questionnaires 6 months after discharge. The mean changes in all MLHFQ domains followed a trend (P < 0.0001) with larger gains in quality of life among patients classified as "improved", smaller gains among those classified as "the same", and losses among those classified as "worsened". The SES and SRM responsiveness parameters in the "improved" group were ≥ 0.80 on nearly all scales. Among patients classified as "worsened", effect sizes were < 0.40, while among patients classified as "the same", the values ranged from 0.24 to 0.52. The MDC ranged from 7.27 to 16.96. The MCID based on patients whose response to the anchor question was "somewhat better", ranged from 3.59 to 19.14 points. CONCLUSIONS: All of these results suggest that all domains of the MLHFQ have a good sensitivity to change in the population studied.

Prognostic value of glomerular filtration rate estimation equations in acute heart failure with preserved versus reduced ejection fraction.

AIMS: Renal function is an important prognostic factor in heart failure. The aim of this study was to compare the predictive value of estimated renal function calculated by the Chronic Kidney Disease-Epidemiology Collaboration equation (CKD-EPI) and the abbreviated Modification of Diet in Renal Disease (MDRD-4) equation for long-term all-cause mortality in patients admitted for acute decompensated heart failure (ADHF) with both preserved ejection fraction (HF-PEF) and reduced ejection fraction (HF-REF). METHODS AND RESULTS: We evaluated patients included in the Spanish National Registry of Heart Failure (RICA). RICA is a multicentre, prospective, cohort study that included patients admitted to the Internal Medicine units with ADHF. Estimated glomerular filtration rate (eGFR) was calculated with CKD-EPI and MDRD-4 equations. A total of 1805 patients admitted for ADHF were studied (52% women; median age 80 years, interquartile range 73.9-84.6 years); of these, 1044 (58%) had HF-PEF. eGFR values were lower with the CKD-EPI formula than with the MDRD-4 formula (51 ml/min/1.73 m(2) vs. 55.7 ml/min/1.73 m(2) ; p < 0.001). The two formulas provided independent prognostic information over long-term follow-up, in both HF-PEF and HF-REF patients. However, in HF-PEF patients, CKD-EPI equation was associated with a significant improvement in reclassification analyses (net reclassification improvement 6.78%; p = 0.009). CONCLUSIONS: In this clinical cohort of ADHF patients, eGFR as calculated by both the CKD-EPI and the MDRD-4 formulas offered similar prognostic information, irrespective of ejection fraction status, but in HF-PEF patients specifically, the CKD-EPI formula seems to improve clinical risk stratification as compared with MDRD-4.

Comorbidity in heart failure. Results of the Spanish RICA Registry.

BACKGROUND: We sought to identify the comorbidities associated with heart failure (HF) in a non-selected cohort of patients, and its influence on mortality and rehospitalization. DESIGN AND METHODS: Data were obtained from the 'Registro de Insuficiencia Cardiaca' (RICA) of the Spanish Society of Internal Medicine. The registry includes patients prospectively admitted in Internal Medicine units for acute HF. Variables included in Charlson Index (ChI) were collected and analysed according to age, gender, left ventricular ejection fraction (LVEF) and Barthel Index. The primary end point of study was the likelihood of rehospitalization and death for any cause during the year after discharge. RESULTS: We included 2051 patients, mean age 78 and 53% females. LVEF was ⩾ 50% in 59.1% of the cohort. There was a high degree of dependency as measured by Barthel Index (14.8 % had an index ≤ 60). Mean ChI was 2.91 (SD ± 2.4). The most frequent comorbidities included in ChI were diabetes mellitus (44.3%), chronic renal impairment (30.8%) and chronic obstructive pulmonary disease (COPD) (27.4%). Age, myocardial infarction, peripheral artery disease, dementia, COPD, chronic renal impairment and diabetes with target-organ damage were all identified as independent prognostic factors for the combined end point of rehospitalization and death at 1 year. However, if multivariate analysis was done including ChI, only this remained as an independent prognostic factor for the combined end point (P < 0.001). CONCLUSIONS: HF is a comorbid condition. ChI is a simple and feasible tool for estimating the burden of comorbidities in such population. We believe that a holistic approach to HF would improve prognosis and the relief the pressure exerted on public health services.

Characterization of the pelagic fish community of the north-western and northern Spanish shelf waters.

This study demonstrates the utility of trawl data, collected during acoustic surveys of pelagic fish stocks as a way of confirming fish identification, to characterize the pelagic community, as well as allowing description and prediction of fish distribution patterns, based on data from Spanish Atlantic Ocean shelf surveys during spring 2005-2011. The composition of the pelagic community is described, as well as spatial and temporal patterns of variation in both the community composition and the presence and importance of two of the main exploited pelagic species, sardine Sardina pilchardus and anchovy Engraulis encrasicolus. The most important species in terms of both frequency of occurrence and standardized mass in hauls were mackerel Scomber scombrus, hake Merluccius merluccius, horse mackerel Trachurus trachurus, S. pilchardus and bogue Boops boops. Multivariate analysis indicated significant effects of depth, geographical area and year on haul composition. Descriptive generalized additive models (GAM), with latitude, longitude and depth as predictors, identified clear spatial patterns in the occurrence and abundance of both S. pilchardus and E. encrasicolus, with abundance being highest closer to the coast and, in the case of E. encrasicolus, higher near the French and Portuguese borders. Further GAM analysis, using environmental variables to explain spatial patterns, revealed significant effects of depth and sea surface temperature (SST) gradient and depth on S. pilchardus importance, while E. encrasicolus importance was related to SST. The importance of both species in hauls was higher in the years of higher spawning stock biomass (SSB) and E. encrasicolus also appeared to expand its range when SSB was higher.

TAXOCENOSIS DE MOLUSCOS Y CRUSTÁCEOS EN RAÍCES DE Rhizophora mangle (RHIZOPHORACEAE) EN LA BAHÍA DE CISPATÁ, CÓRDOBA, COLOMBIA / Taxocenosis of mollusks and crustaceans on roots of Rhizophora mangle (Rhizophoraceae) at Cispatá Bay, Córdoba, Colombia

A pesar del conocimiento existente sobre la ecología de los manglares en la bahía de Cispatá, pocos estudios han sido enfocados en la asociación de invertebrados en las raíces del mangle rojo, por lo que entre diciembre 2010 y septiembre 2011, se caracterizó la taxocenosis de moluscos y crustáceos en raíces de Rhizophora mangle en dos sectores de muestreo de la bahía de Cispatá, Colombia. Para la recolección del material biológico se tomaron al azar tres raíces de mangle homogéneas en cuanto al diámetro. Los moluscos y crustáceos fueron obtenidos de la raíz raspando la superficie con un cuchillo, luego fueron separados y fijados en formalina al 10 % para su posterior identificación hasta especie mediante claves taxonómicas especializadas. De los 12289 individuos recolectados en los cuatro muestreos, 10470 pertenecieron al phylum Mollusca (85,2 %) y los restantes 1819 al subphylum Crustacea (14,8 %). De moluscos se identificaron 14 especies distribuidas en 11 familias y dos clases; Bivalvia y Gastropoda. De crustáceos se identificaron 24 especies distribuidas en 16 familias y cuatro órdenes; Sessillia, Decapoda, Isopoda y Amphipoda. En los dos sectores de muestreo Mytella charruana, Balanus eburneus y Crassostrea rhizophorae fueron las especies más importantes en términos de abundancia, no obstante se sabe que moluscos como M. charruana y B. eburneus presentan una gran capacidad de adaptación y ajuste a las variaciones hidroclimáticas, lo que se reflejó en la dominancia de dichas especies en el sector con mayor influencia del río Sinú. La presencia de los crustáceos Petrolisthes armatus y Aratus pisonii en el sector con más cercanía al mar Caribe, indica que son especies de bosques de manglar con gran movilidad y mecanismos de adaptación fisiológicos.

Despite the existing knowledge on the ecology of mangroves at Cispatá Bay, few studies have focused on the association of invertebrates on red mangrove roots, so between December 2010 and September 2011, it was characterized taxocenosis of mollusks and crustaceans on roots of Rhizophora mangle in two study sites at Cispatá Bay, Colombia. For the collections of biological material were randomly taken three homogeneous mangrove roots in diameter. Mollusks and crustaceans were obtained from the root surface with a scraping knife then were removed and fixed in 10 % formalin for later identification to species using specialized taxonomic keys. Of the 12289 individuals collected in the four samples, 10470 belonged to the phylum Mollusca (85,2 %) and the remaining 1819 to subphylum Crustacea (14,8 %). For mollusks were identified 14 species distributed in 11 families and two classes; Bivalvia and Gastropoda. For crustaceans were identified 24 species distributed in 16 families and four orders; Sessillia, Decapoda, Isopoda and Amphipoda. In both sectors sampling Mytella charruana, Balanus eburneus and Crassostrea rhizophorae were the most important species in terms of abundance, however mollusks like M. charruana and B. eburneus have a great ability to adapt and adjust to changing hydroclimatic, which was reflected in the dominance of these species in the sector with the greatest influence Sinu River. The presence of crustaceans Petrolisthes armatus and Aratus pisonii in the sector with more proximity to the Caribbean Sea indicate that are species with great mobility and physiological adaptation mechanisms.

Crustáceos decápodos asociados a ensamblajes macroalgales en el litoral rocoso de Córdoba, Caribe colombiano / Decapod crustaceans associated with macroalgae assemblages on the rocky coastline of Córdoba, Colombian Caribbean

Objetivo. Determinar la estructura de las poblaciones de crustáceos decápodos asociados a ensamblajes algales en el litoral rocoso del departamento de Córdoba. Materiales y métodos. Para la recolección de los especímenes se delimitó con un cuadrante de 625 cm2, un área con cinco repeticiones dispuestas al azar en cada estación. Para la separación de las macroalgas desde su disco de fijación en el sustrato, se empleó una espátula metálica. En un recipiente plástico se separaron los crustáceos decápodos del resto del material y se conservaron en alcohol al 70%. Resultados. Se identificaron representantes de 50 especies asociadas a los céspedes algales, agrupadas en 16 familias y 29 géneros. Especies como Acanthonyx petiverii, Epialtus bituberculatus, Eurypanopeus abbreviatus y Pachycheles serratus, presentaron un rango amplio de distribución, siendo características en las dos ecorregiones de estudio. Los cambios en cobertura de algas rojas como Gracilaria mammillaris, Hypnea musciformis y Acanthophora muscoides, determinaron la mayor asociación de crustáceos decápodos en la ecorregión Morrosquillo, mientras que los cambios en cobertura de G. damaecornis y Padina gymnospora, fueron las que determinaron la mayor asociación de crustáceos decápodos en el Darién cordobés. Conclusiones. Los resultados indicaron que las especies de crustáceos decápodos asociados a ensamblajes macroalgales, no se encontraron distribuidas de forma similar en las dos ecorregiones estudiadas, siendo P. armatus la especie con mayor porcentaje de abundancia en la ecorregión Morrosquillo, y E. bituberculatus en el sector comprendido entre los municipios de Moñitos y Los Córdobas.

Multidisciplinary approach for the treatment of gastric cancer.

Gastric cancer is a global phenomenon and is the second leading cause of cancer-related deaths worldwide. The highest rates of gastric cancer are seen in Asia and parts of Eastern Europe. In Western countries, the incidence of gastric cancer has declined over the last several decades. At the same time, the distribution of gastric tumors has shifted towards more proximal location in Western patients compared to their Asian counterparts. The most common risk factors include dietary factors, smoking, acid hyposecretory conditions, and H. pylori infection. Clinical diagnosis is made by obtaining a good history and physical exam, complemented by endoscopy and imaging studies. Patients often have advanced disease at time of diagnosis. In the absence of metastases, and provided that the patient is medically fit, surgery is the mainstay of treatment. The extent of gastric resection, including the extent of lymph node dissection, varies by region, with more extensive operations being done in Asia, particularly Japan. Because of the propensity of gastric cancer to recur both locally and distantly, additional therapies including chemotherapy and radiation therapy are recommended along with surgery. These can be administered pre-, peri-, or postoperatively based on institutional practices. As with surgical technique, how and when these additional treatments are offered depends largely on regional practice. In the setting of unresectable, or metastatic disease, palliative options including endoscopic and surgical interventions, radiotherapy, and chemotherapy are available.

Dinámica espacill de crustáceos decápodos asocidos a céspedes algales en el deepartamento de córdoba, caribe Colombinno / Spatial Scale of Crustaceans Decapods Associated with Algal Assemblages in Department of Cordoba, Colombian Caribbean

Se realizó un estudio de la dinámica espacial de los crustáceos decápodos asociados a céspedes algales en los municipios de Moñitos, Puerto Escondido y Los Córdobas, Caribe colombiano. Se efectuaron cuatro muestreos trimestrales entre agosto de 2006 y julio de 2007 en cinco puntos de muestreo; dos en Moñitos, dos en Puerto Escondido y uno en Los Córdobas. Para la recolección de los especímenes se delimitó un cuadrante de 625 cm² con cinco repeticiones dispuestas al azar en cada punto de muestreo. Las macroalgas fueron separadas desde su disco de fijación al sustrato y conservadas en bolsas plásticas. Los crustáceos decápodos se conservaron en alcohol al 70%. Se identificó un total de 27 especies de crustáceos decápodos asociadas a los céspedes algales, agrupadas en 13 familias y 19 géneros, registrándose por primera vez Hippolyte pleuracanthus para el Caribe colombiano. Con base en el análisis de clasificación (UPGMA), se determinó que la estructura de las poblaciones de decápodos está relacionada con las características del sustrato rocoso y la composición algal, indicando que las diferencias en las poblaciones son consecuencia de una escala espacial. Los resultados indicaron que de las 27 especies identificadas, Epialtus bituberculatus registró el mayor porcentaje de abundancia (65,7%), seguida de Pachygrapsus transversus (6,2%), Eurypanopeus abbreviatus (3,8%), Acanthonyx petiverii (3,6%), Panopeus sp1. (3,6%) y Panopeus sp2. (3,4%). El resto de las especies aportaron una abundancia ≤2,2%.

A spatial scale study of decapods crustacean associated with algal assemblages was conducted at Moñitos, Puerto Escondido and Los Córdobas, Colombian Caribbean. During August of 2006 and July of 2007 were realized four samplings in five station; two in Moñitos, two in Puerto Escondido and one in Los Cordobas. A quarter of 625 cm2 was used to collect the species with five repetitions which were chosen at random, in each station. To separate the macroalgae from hold fast, it was used palette knife. The decapods crustaceans were separate in a plastic recipient, and those were preserved in alcohol at 70%, in bottles of plastic which were carefully named. 27 species of decapods associated with algae assemblages were reported, grouped in 13 families and 19 genera. Hippolyte pleuracanthus was registered for first time for the Colombian Caribbean. According to the classification analyses (UPGMA), it was found that the structure of the decapods crustacean were related with characteristic rocky line and algae assemblages, indicating that the differences in the population were consequences of a spatial patterns. The results indicated that of the 27 species identified, Epialtus bituberculatus recorded the highest percentage of abundance (65.7%), followed by Pachygrapsus transversus (6,2%), Eurypanopeus abbreviatus (3,8%), Acanthonyx petiverii, Panopeus sp1. (3,6%) and Panopeus sp2. (3,4%). The rest of the species provided an abundance ≤ 2.2%.

Diet, serum insulin-like growth factor-I and IGF-binding protein-3 in European women.

OBJECTIVE: The aim of this study was to examine the relationship of diet with serum insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 in women. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: The population are 2109 women who were control subjects in a case-control study of breast cancer nested in the European Prospective Investigation into Cancer and Nutrition. Control subjects were randomly chosen among risk sets consisting of female cohort members alive and free of cancer (except non-melanoma skin cancer) at the time of diagnosis of the index case. Matching criteria were age at enrolment, follow-up time, time of the day of blood collection and study centre. Diet was measured through validated questionnaires. Serum hormone concentrations were measured by enzyme-linked immunosorbent assays. The relationship between serum IGF-I, IGFBP-3, and intake of nutrients and foods was explored by linear regression in models adjusted for energy intake, age, body mass index, smoking, physical activity, centre and laboratory batch. RESULTS: Serum IGF-I levels were positively related to protein intake (P(trend)<0.001), but not related to energy, fat or carbohydrate intake. Positive relationships were observed with the intake of milk (P(trend)=0.007), calcium (P(trend)<0.001), magnesium (P(trend)=0.003), phosphorus (P(trend)<0.001), potassium (P(trend)=0.002), vitamin B6 (P(trend)=0.03), vitamin B2 (P(trend)=0.001) and inverse relationships with vegetables (P(trend)=0.02) and beta-carotene (P(trend)=0.02). IGFBP-3 was not related with most of the nutrients and foods in this study. CONCLUSIONS: In this population, circulating IGF-I is modestly related with the intake of protein and minerals, and with milk and cheese, while IGFBP-3 does not appear to be related with diet.

Virulence, horizontal transmission, and sublethal reproductive effects of Metarhizium anisopliae (Anamorphic fungi) on the German cockroach (Blattodea: Blattellidae).

Virulence of Metarhizium anisopliae (Metschnikoff) Sorokin strain EAMa 01/121-Su against the German Cockroach, Blatella germanica (L.), was determined using four concentrations ranging from 4.2 x 10(6) to 4.2 x 10(9) spores per milliliter. The LD50 value was 1.4 x 10(7) spores per milliliter (56,000 spores per cockroach) and LT50 values were 14.8 days and 5.3 days for 4.2 x 10(8) and 4.2 x 10(9) spores per milliliter, respectively. An experiment was conducted to evaluate whether a fungal transmission could exist among infected and healthy cockroaches. Percentage mortality at a ratio of 1:10 of infected to unexposed cockroaches was 87.5% and LT50 was 12.2 days, which indicated the potential of this strain to be horizontally transmitted and to rapidly spread the infection in the insect population. The effect of a sublethal dose (ca. LD60) of M. anisopliae EAMa 01/121-Su strain, applied topically on German cockroaches, was studied by reciprocal crossing. Othecal production, oothecal hatchability, and nymphal production declined upon exposure to M. anisopliae EAMa 01/121-Su strain. The mean number of oothecae laid by female was progressively and significantly reduced by fungal treatment from second oviposition period onwards. Oothecal hatch of fungally challenged females was reduced by 46-49%, oothecal viability by 48-85%, and nymphal production by 22-35%. Only treated females showed an effect on oothecal production, oothecal hatch, and nymphal production, although oothecal hatch was also governed by treated males at a higher significance level. Our results on virulence and horizontal transmission of fungal conidia of M. anisopliae EAMa 01/121-Su strain and its sublethal reproductive effects on German cockroach females are discussed in terms of its potential to decrease the pest status of B. germanica in the short and long terms.

Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy.

BACKGROUND: Hyperparathyroidism is associated with subjective feelings of fatigue and depression as well as limitations in physical activity from musculoskeletal complaints. These quality of life symptoms are not widely accepted as an indication for parathyroidectomy. This study quantifies and compares subjective symptoms of patients with hyperparathyroidism before and after surgery. METHODS: Between February 2001 and June 2002, 61 patients (14 males and 47 females, mean age of 60.8+/-14.4 years) underwent parathyroidectomy. There were 45 patients with single-gland adenomas, 9 patients with double adenomas, 3 patients with primary hyperparathyroidism from 4-gland hyperplasia, 3 patients with secondary hyperparathyroidism, and 1 patient with tertiary hyperparathyroidism. Patients filled out a 53-question survey based on the Health Outcomes Institute Health Status Questionnaire 2.0 before surgery, 1 month postoperatively, and 3-24 months postoperatively. The survey included questions on overall health, daily activities, mood, and medical conditions. Surveys were analyzed for changes in symptoms attributable to parathyroidectomy. Serum calcium and intact parathyroid hormone levels were obtained preoperatively and at 1- and 3-month follow-up visits. RESULTS: At both postoperative evaluations, patients' perception of general health, muscle strength, energy level, and mood significantly improved (P<.05). Moreover, there was a significant correlation between the changes in serum calcium and intact parathyroid hormone levels and improvement in symptoms. CONCLUSIONS: Parathyroidectomy for hyperparathyroidism is associated with significant improvement in patient quality of life. These subjective symptoms represent a valid indication for parathyroidectomy.

[Factors associated with the development of atopy in young adults]. / Factores asociados al desarrollo de atopia en adultos jóvenes.

BACKGROUND: To determine the risk factors for the development of atopy in Spanish young adults. SUBJECTS AND METHODS: Case-control study over prevalent cases. Carried out in general population between the ages of 20 to 44 years old. Spanish participants of the ECRHS, a random representative sample of Spanish young adults (n = 16,884), and a 20% randomised subsample made by those who answered to a short respiratory questionnaire and had atopy assessed, was studied. Atopy was defined as having serum specific IgE positivity to the following aeroallergnes: cat dander, Cladosporium herbarum, Dermatophagoides pteronyssinus, Parietaria judaica and Phleum pratense. RESULTS: Several factors had a statistically significant effect. In addition to male gender and lower age, maternal allergy (OR = 1.63; 95% CI = 1.11-2.40), having allergic siblings (OR = 1.40; 95% CI = 1.06-1.90) and a higher educational level (OR = 1.69; 95% CI = 1.22-2.34) were associated with the presence of high levels of specific IgE in our sample. Moreover, having had older siblings, especially older brothers appears to be a protective factor to the development of atopy but not in a statistically significant way, while having had pet birds during childhood appears to enhance the risk. CONCLUSIONS: In addition to the familial variables that indicates both environmental and genetic factors, educational level seems to have low degree of association with atopy; this feature shows that variables related with life style are involved in atopy development.

[Epidemiology of delirium in elderly inpatients]. / Epidemiología del delirio en ancianos hospitalizados.

Our objective was to determine delirium incidence and risk factors in a cohort of elderly inpatients. We randomly selected 149 patients, aged 65 years or older, from admission to general wards, without evidence of delirium. They were evaluated daily with the Confusion Assessment Method, an instrument validated for the diagnosis of delirium. We obtained relative risks for delirium and those independently associated were included in a logistic regression model. We used the chi-square test with Yate's corrections for univariate analysis, and t-test for comparisons of means. We observed that 51 patients (20.5%) developed delirium during their hospital stay. Severity of disease (RR 1.28, 1.14-1.43), having chronic diseases (RR 3.45, 2.4-4.96), and having fever at admission (RR 1.84, 1.33-2.56) were found independently associated with delirium. Patients who developed delirium had longer hospital stay (9.87 days +/- 3.48 vs 6.95 days +/- 2.45, p < 0.05) and higher mortality (RR 2.19, CI 1.26-3.79). We conclude that delirium in our setting is very frequent and has negative effects on resource utilization and mortality in elderly inpatients. Its association with the severity of the disease seems interesting. Appropriate prospective identification of patients at risk for delirium may allow the implementation of preventive strategies in order to minimize the impact of this complication.

Epidemiología del delirio en ancianos hospitalizados. / [Epidemiology of delirium in elderly inpatients]

Our objective was to determine delirium incidence and risk factors in a cohort of elderly inpatients. We randomly selected 149 patients, aged 65 years or older, from admission to general wards, without evidence of delirium. They were evaluated daily with the Confusion Assessment Method, an instrument validated for the diagnosis of delirium. We obtained relative risks for delirium and those independently associated were included in a logistic regression model. We used the chi-square test with Yates corrections for univariate analysis, and t-test for comparisons of means. We observed that 51 patients (20.5

) developed delirium during their hospital stay. Severity of disease (RR 1.28, 1.14-1.43), having chronic diseases (RR 3.45, 2.4-4.96), and having fever at admission (RR 1.84, 1.33-2.56) were found independently associated with delirium. Patients who developed delirium had longer hospital stay (9.87 days +/- 3.48 vs 6.95 days +/- 2.45, p < 0.05) and higher mortality (RR 2.19, CI 1.26-3.79). We conclude that delirium in our setting is very frequent and has negative effects on resource utilization and mortality in elderly inpatients. Its association with the severity of the disease seems interesting. Appropriate prospective identification of patients at risk for delirium may allow the implementation of preventive strategies in order to minimize the impact of this complication.

Seudoquistes del pancreas / Management pancreatic pseudocysts

28 pacientes desarrollaron 36 seudoquistes del páncreas.Fueron operados:10 por drenaje externo;12 por derivaciones al tubo digestivo;6 pancreatectomías corporocaudales;1 duodenopancreatectomía;1 resección simple.En tres casos se asistió a la regresión espontánea;en otros dos se ocluyó la cistotrostomía y en un la cistoyeyunoanastomosis.En casos selectos los autores prefieren la resección;en los grandes y comunicantes se inclinan por las anastomosis quistodigestivas.Los inertes de actividad enzimática curan con la derivación externa o la resección.No parecehaber suficientes argumentos por anastomosis bajo control videocópico se halla en etapa de investigación

Seudoquistes del pancreas / Management pancreatic pseudocysts

28 pacientes desarrollaron 36 seudoquistes del páncreas.Fueron operados:10 por drenaje externo;12 por derivaciones al tubo digestivo;6 pancreatectomías corporocaudales;1 duodenopancreatectomía;1 resección simple.En tres casos se asistió a la regresión espontánea;en otros dos se ocluyó la cistotrostomía y en un la cistoyeyunoanastomosis.En casos selectos los autores prefieren la resección;en los grandes y comunicantes se inclinan por las anastomosis quistodigestivas.Los inertes de actividad enzimática curan con la derivación externa o la resección.No parecehaber suficientes argumentos por anastomosis bajo control videocópico se halla en etapa de investigación

Infective endocarditis in children: clinical analyses and evaluation of two diagnostic criteria.

A new diagnostic schema for infective endocarditis (IE), the Duke criteria, has been compared with the previously published criteria of von Reyn in adult patients. This study was designed to analyze the clinical characteristics of a group of pediatric patients with IE and to compare the diagnostic efficiency of both sets of criteria. We reviewed retrospectively the clinical records of 38 patients, 22 with predisposing heart disease (Subgroup A) and 16 with no known cardiologic abnormality (Subgroup B). Ventricular septal defect was the most frequent preexisting heart disease (31.8%) and central venous catheters were the most frequent predisposing factor (68.7%). Comparison of the clinical features between subgroups (A vs. B) showed differences only for the presence of a new regurgitant murmur (9% vs. 44%, P < 0.05) and a hemoglobin value < or = 10 g/dl (50% vs. 94%, P < 0.05). The most frequent microorganisms isolated were viridans streptococci (36%) in Subgroup A and Staphylococcus aureus (50%) in Subgroup B. Of the 6 pathologically confirmed cases all would have been classified as clinically definite by the Duke criteria, as compared with 2 of 6 being defined as probable and one being rejected by von Reyn criteria. Of the 32 cases clinically defined 19 (59%) were classified as definite by the Duke criteria, and 11 (34%) were probable by the von Reyn criteria (difference 25%, P < 0.01). Although no case of IE was rejected by Duke criteria, 8 (25%) were rejected by von Reyn criteria (difference 25%, P < 0.01), with all 8 classified as possible by Duke criteria. We conclude that the Duke criteria were superior to the von Reyn criteria for the diagnosis of pediatric IE, including more cases as definite and significantly fewer cases as rejected.