RESUMEN
BACKGROUND: Workplace aggressions on hospital workers is a very frequent and under-reported problem. OBJECTIVE: The novel objective of our study was to analyze the number of workplace aggressions per hospital worker. Other objectives of the study were to analyze the management knowledge and interest in receiving training on aggressions by hospital workers. METHODS: An anonymous survey was handed out among all professionals in a university hospital. RESULTS: A total of 1118 anonymous surveys were collected. The responders declared that throughout their working life they had suffered some sort of verbal aggression in the hospital in 766 cases (68.5%) and physical aggression in 393 cases (35.2%). Multiple logistic regression analyses found higher risk of receiving physical and verbal aggression in the nursing category and in the Emergency, Critical Care or Psychiatry Units, and a higher risk of receiving physical aggression in women. The score on the level of personal knowledge regarding the legal, physical, and psychological management of aggressions (score 0-10 for each of the 3 aspects) was 2.91±2.68 in legal management, 2.97±2.77 in psychological management and 2.91±2.76 in physical management. The opinion about the interest of receiving training (score from 0 to 10) on the legal management of hospital aggressions was 8.90±1.72, on psychological management was 8.85±1.78 and on physical management was 8.88±1.78. CONCLUSIONS: Workplace aggression on hospital workers mainly affects women, the nursing category and the Emergency, Critical Care or Psychiatry Units. Hospital workers showed little knowledge on the topic but a great interest in receiving training.
Asunto(s)
Agresión , Personal de Hospital , Violencia Laboral , Humanos , Femenino , Masculino , Adulto , Agresión/psicología , Violencia Laboral/psicología , Violencia Laboral/estadística & datos numéricos , Encuestas y Cuestionarios , Persona de Mediana Edad , Personal de Hospital/psicología , Personal de Hospital/estadística & datos numéricos , Prevalencia , Lugar de Trabajo/psicología , Lugar de Trabajo/normas , Hospitales Universitarios , Modelos LogísticosRESUMEN
INTRODUCTION: Transforming growth factor beta-1 (TGF-ß1) is a pleiotropic cytokine. Its relationship with atherosclerosis is debatable, protective or deleterious effects have been described. Alcoholics are at increased vascular risk. Although TGF-ß1 is increased in alcoholics, its role on vascular risk factors has not been analyzed. This is the objective of this study. PATIENTS AND METHODS: 79 heavy alcoholics and 34 controls were included. Calcium deposition in the aortic arch was assessed in the plain thorax X-ray film. Ankle-brachial index was recorded in 48 patients. All the patients underwent complete laboratory evaluation, including serum levels of TGF-ß1, tumor necrosis factor (TNF)-α, interleukin (IL)-4, IL-6, and interferon-γ (IFN-γ).We analyzed the relationships between TGF-ß1 and vascular risk factors by both univariate (parametric or non parametric tests), or multivariate analysis to discern on which variables TGF-ß1 levels depend. RESULTS: Serum TGF-ß1 levels were higher among patients (t = 2.73; P = 0.008), but no differences exist among cirrhotics (17246 ± 11,021 pg/mL) and non-cirrhotics (21,340 ± 12,442 pg/mL). TGF-ß1 showed significant correlations with total cholesterol (r = 0.28; P = 0.017) and HDL- cholesterol (r = 0.25; P = 0.042), and inverse correlations with body mass index (BMI; ρ = -0.37; P = 0.004), IL-4 (ρ = -0.31; P = 0.009), INF-γ (ρ = -0.28; P = 0.001), and IL-6 (ρ = -0.38; P = 0.001). By multivariate analysis, only BMI, IL-6 and HDL-cholesterol showed independent relationships with TGF-ß1. No relationships were observed with ankle-brachial index or calcium in the aortic arch, hypertension, diabetes, left ventricular hypertrophy or atrial fibrillation. CONCLUSION: TGF-ß1 levels are increased in alcoholics, but are unrelated to vessel wall calcification or arterial stiffness.
Asunto(s)
Alcohólicos , Alcoholismo/sangre , Factor de Crecimiento Transformador beta1/sangre , Calcificación Vascular/sangre , Rigidez Vascular/fisiología , Anciano , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Aorta Torácica/metabolismo , Aorta Torácica/patología , Biomarcadores/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Calcificación Vascular/diagnóstico , Calcificación Vascular/epidemiologíaRESUMEN
Cytokine levels are raised in acute alcoholic hepatitis. However, there are disparate results regarding the duration of altered plasma levels, and there are also discrepancies about the relation of changes during the first 15 days after admission with short-term (in-hospital) or long-term mortality. In 56 patients with acute alcoholic hepatitis we found that IL-8, IL-4, Interferon-γ (IFN-γ), malondialdehyde and C-reactive protein remained higher in patients than in 18 age- and sex-matched controls at admission, at the 7th day and at the 15th day after admission. Moreover, IL-4 levels (and to a lesser extent, IL-10 and IFN-γ ones) increased along the three determinations. However, comparing patients who died during the admission with those who did not, there were no statistically significant differences, but there was a nearly significant trend for MDA (Z=1.89; p=0.059), with higher levels among those who died. When changes between the first and the second determinations were compared with long-term survival, only IL-8 and IFN-γ showed a relation with mortality. IFN-γ values increased among those who survived and decreased among those who died (p=0.048). IFN-γ values at the first determination also showed a relation with long-term mortality, especially when patients with IFN-γ values in the first quartile were compared with those of the 4th one (log rank=5.64; p=0.018; Breslow=4.64; p=0.031). Besides Interferon-γ, only C-reactive protein showed differences between the first and the 4th quartile regarding mortality (Log rank=4.50; p=0.034; Breslow 4.33; p=0.038). In contrast with other studies, no relation was found between TNF-α or IL-6 and mortality.
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Proteína C-Reactiva/análisis , Citocinas/sangre , Hepatitis Alcohólica/sangre , Hepatitis Alcohólica/mortalidad , Interferón gamma/sangre , Adulto , Femenino , Mortalidad Hospitalaria , Humanos , Interleucina-4/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , Admisión del Paciente , Análisis de Supervivencia , Factor de Necrosis Tumoral alfa/sangreRESUMEN
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Humanos , Factor V , Oclusión de la Arteria Retiniana/fisiopatología , Neuritis Óptica/fisiopatologíaRESUMEN
We report the case of a 56 year old cirrhotic woman who presented during the course of a tuberculous spondylodiscitis affecting T9-T10, a clinical picture consistent with neuralgic amyotrophy affecting the right shoulder first, and later also the left one (Parsonage-Turner syndrome). This is an uncommonly diagnosed entity of unknown etiology and pathogenesis. Magnetic resonance images (MRI) include high signal intensity in supra and infraspinatus muscles and other muscles of the shoulder girdle, compatible with muscle oedema associated with denervation. These features, combined with the ability of MRI to exclude local problems as tendinitis stresses the importance of this technique in the diagnostic evaluation of patients with neuralgic amyotrophy.
Asunto(s)
Discitis/complicaciones , Discitis/microbiología , Cirrosis Hepática/complicaciones , Dolor/etiología , Enfermedades del Sistema Nervioso Periférico/etiología , Vértebras Torácicas , Tuberculosis de la Columna Vertebral/complicaciones , Brazo , Femenino , Humanos , Persona de Mediana EdadRESUMEN
El síndrome de Parsonage-Turner o neuralgia amiotrófica del hombro es una entidad de etiología y patogenia desconocidas. Cursa con dolor intenso localizado en hombro y región proximal del miembro superior, especialmente nocturno, seguido de amiotrofia y debilidad. Se ha descrito en relación con infecciones víricas o bacterianas, procesos inflamatorios o intervenciones quirúrgicas, y suele tener una evolución favorable. Presentamos el caso de una paciente de 56 años de edad, afecta de cirrosis hepática de origen alcohólico, diagnosticada tres meses antes de espóndilodiscitis tuberculosa que afectaba a D9 y D10, que presenta de forma súbita dolor y amiotrofia en hombro y brazo derecho, seguido a las pocas semanas de afectación del lado izquierdo. Un estudio electrofisiológico confirmó el diagnóstico, y se realizó resonancia nuclear magnética, procedimiento diagnóstico útil en estas situaciones, especialmente cuando se planteaba el diagnóstico diferencial con tendinitis por quinolonas
We report the case of a 56-year old cirrhotic woman who presented during the course of a tuberculous spondylodisctis affecting T9-T10, a clinical picture consistent with neuralgic amyotrophy affecting the right shoulder first, and later also the left one (Parsonage-Turner syndrome). This is an uncommonly diagnosed entity of unknown etiology and pathogenesis. Magnetic resonance images (MRI) include high signal intensity in supra and infraspinatus muscles and other muscles of the shoulder girdle, compatible with muscle o edema associated with denervation. These features, combined with the ability of MRI to exclude local problems as tendinitis stresses the importance of this technique in the diagnostic evaluation of patients with neuralgic amyotrophy
Asunto(s)
Femenino , Adulto , Humanos , Neuritis del Plexo Braquial/diagnóstico , Neuritis del Plexo Braquial/patología , Extremidad Superior/patología , Extremidad Superior/fisiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/etiología , Tuberculosis de la Columna Vertebral/diagnóstico , Tuberculosis de la Columna Vertebral/etiología , Neuritis del Plexo Braquial/etiología , Hombro/lesiones , Hombro/fisiopatología , Cirrosis Hepática/diagnóstico , Tuberculosis de la Columna Vertebral/patologíaRESUMEN
We report the case of a 39-year-old male patient affected by type B Niemann-Pick disease, in whom pulmonary involvement became evident 15 years after the initial diagnosis. Pulmonary involvement was discovered incidentally during the evaluation of a dry cough and exertional dyspnoea which occurred in the context of an acute febrile, self-limiting illness. In this case, the pulmonary involvement is clinically mild, with minimal alteration of the diffusing capacity for carbon monoxide (DL(CO)), despite moderate fibrosis and widespread infiltration of both alveoli and interstitium by sea blue histiocytes.
Asunto(s)
Enfermedades Pulmonares/complicaciones , Enfermedades de Niemann-Pick/complicaciones , Adulto , Humanos , Hallazgos Incidentales , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Masculino , Enfermedades de Niemann-Pick/diagnóstico por imagen , Enfermedades de Niemann-Pick/patología , Tomografía Computarizada por Rayos XAsunto(s)
Anemia Hemolítica/complicaciones , Crioglobulinemia/complicaciones , Hepatitis C Crónica/complicaciones , Hipotiroidismo/complicaciones , Interferón-alfa/uso terapéutico , Anciano , Anemia Hemolítica/tratamiento farmacológico , Anemia Hemolítica/virología , Crioglobulinemia/tratamiento farmacológico , Crioglobulinemia/virología , Femenino , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/virología , Resultado del TratamientoRESUMEN
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Anciano , Femenino , Humanos , Biomarcadores , Nódulo Tiroideo , Interferón-alfa , Resultado del Tratamiento , Hepatitis C Crónica , Crioglobulinemia , Anemia Hemolítica , HipotiroidismoRESUMEN
No disponible
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Persona de Mediana Edad , Masculino , Humanos , Tabaquismo , Tórax , Enfisema Pulmonar , Circulación Colateral , Diagnóstico Diferencial , Hemoptisis , Hipotiroidismo , Neoplasias del MediastinoRESUMEN
Chronic alcoholics frequently show associated malnutrition. Both ethanol and malnutrition exert profound changes on zinc and copper metabolism. In this study, we found higher hair zinc and copper values in 43 male alcoholics than in 39 controls. Hair copper was significantly related to the amount of ethanol consumed, whereas hair zinc was higher in consumers of distilled beverages. No relation was observed between hair zinc and copper and nutritional status, kind of diet consumed, style of life, and liver cirrhosis. Consequently, hair zinc and copper levels are related only with alcohol intake.
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Alcoholismo/metabolismo , Cobre/análisis , Cabello/química , Zinc/análisis , Adulto , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Alcoholismo/complicaciones , Peso Corporal , Conducta Alimentaria , Humanos , Masculino , Persona de Mediana Edad , Trastornos Nutricionales/complicaciones , Trastornos Nutricionales/metabolismo , Fenómenos Fisiológicos de la NutriciónRESUMEN
We studied 174 patients with SIRS criteria, 45 with sepsis, eight with severe sepsis and 13 with septic shock. Serum TNF-alpha, IL-6, IL-8 and IL-10 levels were raised in SIRS patients, even in those cases in which an infection could not be documented, and more intensely in severe sepsis and in patients who died (11%). The slope of the regression line between IL-10 and TNF-alpha was sharper in patients with severe sepsis and in those who died; an imbalance between pro- and anti-inflammatory cytokines may be related to poor prognosis. Increased IL-6 and IL-10, decreased muscle mass, raised BUN and low body temperature were all independently related to prognosis.
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Inflamación/inmunología , Sepsis/diagnóstico , Sepsis/inmunología , Choque Séptico/diagnóstico , Choque Séptico/inmunología , Factores de Edad , Anciano , Temperatura Corporal , Citocinas/biosíntesis , Femenino , Humanos , Interleucina-10/biosíntesis , Interleucina-10/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Cinética , Masculino , Persona de Mediana Edad , Músculos/patología , Pronóstico , Sepsis/mortalidad , Choque Séptico/mortalidad , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
BACKGROUND: The natural history of HIV infection and its related diseases has changed after the introduction of new potent antiretroviral therapies (HAART). We have performed this study to analyse in our hospital the natural history of HIV infection in relation to the therapeutics advances. PATIENTS AND METHODS: We have exhaustively revised the clinic records of all the 807 adult HIV-infected patients followed at the HUC from January 1985 to December 1999. RESULTS: The incidence of most opportunistic diseases, new AIDS cases, hospital admissions and deaths decreased as from 1997. Patients who started antiretroviral therapy with HAART had lower incidence of AIDS, hospital admissions and deaths than patients with other therapy modalities. Survival of patients placed on HAART was better than that of patients who received different therapy modalities (p < 0.001), independently on the intensity of immunosuppression and AIDS diagnosis. Multivariate analysis showed that HAART therapy was the best protector factor, decreasing the risk of progression to death (p < 0.001). CONCLUSIONS: HAART therapy leads an important improvement of survival of HIV infected patients, independently an the intensity of immunosuppression and slows HIV progression, decreasing the number of new AIDS cases, hospital admissions and deaths.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Femenino , Infecciones por VIH/mortalidad , Humanos , Incidencia , Masculino , Análisis Multivariante , España/epidemiología , Factores de TiempoAsunto(s)
Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Cocos Grampositivos/aislamiento & purificación , Infecciones Oportunistas/microbiología , Delirio por Abstinencia Alcohólica/complicaciones , Alcoholismo/complicaciones , Ampicilina/uso terapéutico , Cefazolina/uso terapéutico , Terapia Combinada , Enfermedades Desmielinizantes/complicaciones , Complicaciones de la Diabetes , Quimioterapia Combinada/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/cirugía , Gentamicinas/uso terapéutico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/etiología , Infecciones por Bacterias Grampositivas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/etiología , Infecciones Oportunistas/cirugía , StentsRESUMEN
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Persona de Mediana Edad , Adolescente , Masculino , Humanos , Fenitoína , Síndromes de Neurotoxicidad , AnticonvulsivantesRESUMEN
Objetivo: En el pronóstico del paciente hospitalizado influyen, entre otros factores, el estado de nutrición, la intensidad de la reacción de fase aguda (RFA) y la gravedad de la enfermedad. Estos tres factores están estrechamente interrelacionados: la enfermedad, a través de la RFA mediada por citoquinas, produce desnutrición, más intensa cuanto más grave es la enfermedad. Nuestro objetivo es analizar en que medida los mencionados factores están relacionados con la mortalidad y cuáles de ellos tienen valor predictivo independiente. Método: Se ha estudiado a 119 pacientes ingresados consecutivamente en una unidad de cuidados intermedios, en los que se realizó una valoración nutricional objetiva y subjetiva, determinaciones bioquímicas nutricionales, reactantes de fase aguda y citoquinas IL-1, FNTa e IL-6. La gravedad de la enfermedad se valoró a través de la existencia de insuficiencia de órganos. Se consideró como único punto final el fallecimiento o el alta hospitalaria del paciente. Resultados: Se relacionaron con mayor mortalidad un peor estado de nutrición, tanto los antecedentes de alimentación deficiente, como una peor valoración nutricional subjetiva, la elevación de la IL-6, el aumento del porcentaje de neutrófilos, el descenso de los linfocitos, de la hemoglobina, de la transferrina y la anergia al PPD; también la existencia de alguna de las siguientes complicaciones o insuficiencia de órganos: sepsis, ventilación mecánica, shock, insuficiencia renal aguda y alteraciones de la coagulación. En el análisis multivariante (regresión logística) sólo las variables nutricionales, la existencia de sepsis y los datos de insuficiencia de órganos mostraron valor pronóstico independiente, mientras que la IL-6 era desplazada por los datos de fallo de órganos. Conclusión. De cara al pronóstico, la gravedad de la enfermedad y el estado de nutrición aportan información independiente, mientras que la IL-6 queda desplazada, probablemente debido a su estrecha relación con la respuesta inflamatoria y la existencia de fallo de órganos (AU)
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Adulto , Anciano , Femenino , Masculino , Persona de Mediana Edad , Anciano de 80 o más Años , Humanos , Interleucina-1 , Interleucina-6 , Trastornos Nutricionales/epidemiología , Prevalencia , Pronóstico , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa , Enfermedad Crítica/mortalidad , Interleucina-1/sangre , Interleucina-6/sangre , Estado Nutricional , Factor de Necrosis Tumoral alfa/análisisRESUMEN
OBJECTIVE: Prognosis of hospitalized patients depends on the status of nutrition, the intensity of the biologic inflammatory response or acute phase response (APR), triggered by cytokine, and the illness severity. These factors have been shown closely related, as cytokine causes malnutrition and organ failure. AIM: to analyze which of these factors are related to mortality and, by multivariate analysis, which of them have an independent predictive value. METHOD: We include 119 patients admitted to a semi-intensive care unit. Nutritional assessment was performed by mid arm anthropometrics, serum albumin, transferrin, IGF-I, and subjective nutritional evaluation; we also determine acute phase proteins and cytokine IL-1, TNF alpha and IL-6. Severity of illness was assessed by organ failure. The only end point considered was death or survival until discharge of hospital. RESULTS: The following data were related to increased mortality: impaired alimentary habits and nutritional subjective assessment, raised serum levels of IL-6 and neutrophil differential count, decreased lymphocyte count, hemoglobin and serum transferrin levels, a negative PPD and the presence of sepsis, shock or organ failure. At multivariate analysis (stepwise logistic regression) only nutritional variables, sepsis and organ failure data showed an independent predictive value, whereas IL-6 was displaced by organ failure data. CONCLUSION: Regarding prognosis, severity of illness and nutritional status have independent predictive value, whereas IL-6 was displaced, probably because it is closely related to the inflammatory response and to organ failure.