Puntuación de la escala de Norton al ingreso y mortalidad en pacientes hospitalizados en Medicina Interna / Norton scale score on admission and mortality of patients hospitalised in Internal Medicine departments

Objetivo. Determinar la asociación entre la puntuación de la escala de Norton (que valora el riesgo de padecer úlceras por presión) y la mortalidad a corto, medio y largo plazo en los pacientes hospitalizados en Medicina Interna. Pacientes y métodos. Estudio de cohortes prospectivo, unicéntrico, de pacientes ingresados en los meses de octubre de 2010, y enero, mayo y octubre de 2011. Se recogieron la edad, sexo, índice de Barthel, escala de Norton, presencia de úlceras por presión, categoría diagnóstica mayor, estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se dividió a los pacientes según las categorías de riesgo de la escala de Norton. El seguimiento fue de 3 años. Resultados. Se incluyeron 624 pacientes con una edad mediana (rango intercuartílico) de 79 (17) años y una puntuación mediana en la escala de Norton de 16 (7). Durante el ingreso fallecieron 74 (11,9%) pacientes, a los 6 meses 176 (28,2%), al año 212 (34,0%), y a los 3 años 296 (47,4%). La mortalidad fue mayor en las categorías de más riesgo en la escala de Norton. La puntuación en la escala de Norton se asoció de forma independiente con la mortalidad a los 6 meses (p<0,001), al año (p=0,005), y 3 años (p=0,002). Las áreas bajo la curva de la escala de Norton fueron 0,746 (IC95% 0,686-0,806), 0,735 (IC95% 0,691-0,780) y 0,751 (IC95% 0,713-0,789), respectivamente (p<0,001). Conclusiones. La escala de Norton es útil para predecir el pronóstico a corto, medio y largo plazo en pacientes ingresados en Medicina Interna

Objective. To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments. Patients and methods. A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years. Results. The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (p<.001), at 1 year (p=.005), and at 3 years (p=.002). The areas under the curve of the Norton scale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (p<.001). Conclusions. The Norton scale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments

Norton scale score on admission and mortality of patients hospitalised in Internal Medicine departments. / Puntuación de la escala de Norton al ingreso y mortalidad en pacientes hospitalizados en Medicina Interna.

OBJECTIVE: To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments. PATIENTS AND METHODS: A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years. RESULTS: The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (p<.001), at 1 year (p=.005), and at 3 years (p=.002). The areas under the curve of the Norton scale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (p<.001). CONCLUSIONS: The Norton scale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments.

[Bacteremia in the elderly: associated and prognostic factors]. / Bacteriemia en el anciano: factores asociados y pronósticos.

BACKGROUND: Bacteremia is associated with high morbidity and mortality rates and its prevalence increases with age. The objective of the present investigation was to know the epidemiology, associated factors and prognosis in patients with bacteremia in our environment and in relation with age. METHODS: Two hundred and twenty-nine episodes of bacteremia were prospectively studied; 97 (42%) cases corresponded to patients aged > 70 years. The prognostic factors were evaluated by the univariate and multivariate analysis in the whole cohort and univariate study of associated factors for an age > 70 years. RESULTS: The etiology, infectious sources, nosocomial acquisition, and complications apart from shock (p = 0.02) were similar in the elderly patients. The associations of diabetes (p = 0.05), COPD and/or heart disease (p = 0.01), and exitus were higher for patients > 70 years. The main independent prognostic factor in the series was disseminated intravascular coagulation (p < 0.001, multivariate OR 14.2). CONCLUSIONS: Patients older than 70 years have a higher incidence of shock and mortality associated with infection. The higher overall mortality rate in the series was associated with disseminated intravascular coagulation and multisystemic failure irrespective of age.

[Pulse-oximetry monitoring during endoscopy of the upper digestive tract and chronic obstructive lung disease]. / Monitorización con pulsioximetría durante la endoscopia digestiva alta y enfermedad pulmonar obstructiva crónica.

BACKGROUND: During upper digestive endoscopy arterial desaturations occur which may favour cardiopulmonary complications; therefore, monitoring and oxygen administration to risk patients is recommended. The aim of this study was to evaluate desaturations occurring during endoscopy and whether there are differences between patients with or without prior obstructive respiratory pathology. METHODS: A total of 119 consecutive patients undergoing upper digestive endoscopy were studied. The clinical history and simple spirometry were obtained before endoscopy; during endoscopy, a continuous monitoring of oxygen saturation and heart rate with pulse oximetry. RESULTS: Forty-six patients (38.7%) had oxygen saturations lower than 90% (Group I). Patients were significantly older and FEV-1, FVC, FEF 25-75, and FEV-1/FVC significantly lower among patients in Group I than among the 73 patients (61.3%) with no oxygen desaturation (Group II). A Tiffenau index lower than 70% was not a good predictor for oxygen desaturation during endoscopy. CONCLUSIONS: Pulse-oximetry monitoring during upper digestive endoscopy is recommended and particularly in patients with obstructive respiratory conditions and/or advanced age.

[Varicella pneumonia in previously healthy adults]. / Neumonitis varicelosa en el adulto previamente sano.

Two cases of pneumonia associated with chicken pox in previously healthy patients are described. Their known risk factor was heavy smoking. Both were treated successfully with parenteral aciclovir, although one presented a restrictive spirometric pattern with lowered DLCO that became normal 3 months after discharge.

[Acute respiratory insufficiency secondary to Coxiella burnetii pneumonia: a rare complication]. / Insuficiencia respiratoria aguda secundaria a neumonía por Coxiella burnetii: una complicación excepcional.

Acute respiratory failure secondary to Coxiella burnetii infection is an extremely rare but serious complication that usually has a good prognosis after appropriate treatment. We describe a female patient who developed acute respiratory failure secondary to Coxiella burnetii pneumonia requiring mechanical ventilation and antibiotic therapy.

[Pheochromocytoma secreting adrenaline, a rare form of presentation]. / Feocromocitoma secretor de adrenalina, como forma excepcional de presentación.

We present the case of a 42-year-old patient with a pheochromocytoma, whose clinical form of presentation was extremely rare, due to the high secretion of adrenalin compared to noradrenaline. We stress the relevance of the anamnesis for the diagnosis of this pathology, as well as the problems regarding its clinical, anaesthetic and surgical management. In addition, we review the literature.

[Tracheobronchopathia osteochondroplastica . Apropos a case]. / Traqueobroncopatía osteocondroplástica. A propósito de un caso.

We present one case of osteochondroplastic tracheobronchopathy in a patient with right laterocervical tumoration as a manifestation of a normofunctional nodular goiter detected in a thyroid morphofunctional study, and tracheal stenosis secondary both to the goiter and the tracheobronchial process. The coincidence of these two processes, probably fortuitous, has never been described before.