Ensayo clinico aleatorizado para evaluar la efectividad de dos vias de administracion de hierro, oral e intravenosa, en el tratamiento de la anemia ferropenica posparto / No disponible

Objetivo: Comparar el efecto del tratamiento con hierro oral e intravenoso en la anemia ferropenica posparto. Material y método Trece mujeres con hemoglobina 7-10g/dl y ferritina < 15µg/l a las 24h posparto fueron aleatorizadas en 2 grupos, uno recibió hierro intravenoso (2 dosis de 200mg de hierro sacarosa) los días 2 y 4 tras el parto, y el otro el tratamiento estandar, 200mg de sulfato ferroso oral 2 veces/dia durante 6 semanas. Resultados En el grupo del hierro intravenoso los valores de ferritina el día 7 fueron superiores (p=0,002) (..) (AU)

Objective: To compare the effect of treatment with oral and intravenous iron in postpartumiron deficiency anemia. Material and method: Thirteen women with hemoglobin values of 7-10 g/dl and ferritin values of < 15 microgram/l at 24 h postdelivery were randomized in two groups: one group received intravenous iron (two doses of 200 mg ferrous sucrose) on days 2 and 4 after labor and the other group received standard treatment with oral ferrous sulphate 200 mg twice daily for 6 weeks. Results: By day 7, ferritin levels were significantly higher (p = 0.002) in the group treated with intravenous iron (298.3 ± 159,1 g/l) than in that treated with oral iron (21.3 ± 9.4 g/l). Byday 14, differences between these two groups were also detected (123.7 ± 65.1 g/l in the intravenous iron group and 24.6 ± 9.3 g/l in the oral iron group, p = 0.004). Hemoglobin and hematocrit levels increased in both groups on days 7, 14 and 42 with no statistically significant differences. Adverse effects were detected in the oral iron group only (29%, n = 2), although allwere mild. Conclusions: Intravenous iron could be an alternative in the treatment of postpartum iron deficiency anemia, especially in patients who are unable to tolerate or who reject oral formulations (AU)

[Variations in health-related quality of life in critical patients]. / Variaciones en la calidad de vida relacionada con la salud en los pacientes críticos.

OBJECTIVE: To determine the changes in the health-related quality of life (hRQOL) six months after discharge from the ICU and the conditions associated to them. DESIGN: A prospective cohort study. SETTING: 14 beds medical-surgical intensive care unit (ICU). PATIENTS: A total of 247 patients admitted to our ICU for more than 24 hours with a follow-up of 6 months were study. Those admitted with acute coronary syndrome or for monitoring purposes were excluded. INTERVENTION: A quality of life survey was conducted using the score developed by the PAEEC group (project of the epidemiological analysis of critical illness) to assess hRQOL before ICU admission and 6 months after discharge. RESULTS: The hRQOL deteriorated, going from a median value of 3 to 6 (p < 0.001). The multivariate analysis showed less deterioration of hRQOL in patients with chronic health conditions registered on the APAChE-II score (regression coefficient [RC] = -1.4; 95% CI, -2.5 to -0.2; p < 0.02) and in those with a hRQOL > or = 10 points (RC = -4,4; 95% CI, -5.9 to -2.8; p < 0.001). There was more deterioration in polytraumatized patients (RC = 1.9; 95% CI, 0.6-3.3; p = 0.01) or with renal failure (RC = 3.9; 95% CI, 1.9-5.9; p < 0.001) or in those with a stay duration longer than 10 days (RC = 1.9; 95% CI, 0.6-3.2; p < 0.001). CONCLUSIONS: Most patients experience deterioration of hRQOL. Patients with chronic diseases or with worst previous hRQOL who survive 6 months experience less deterioration of hRQOL than those who are polytraumatized or have renal failure or a longer ICU stay.

Variaciones en la calidad de vida relacionada con la salud en los pacientes críticos / Variations in health-related quality of life in critical patients

Objetivo. Analizar las variaciones de la calidad de vida relacionada con la salud (CVRS) a los 6 meses del alta de la unidad de medicina intensiva (UMI)y los factores que se asocian a estas variaciones. Diseño. Estudio prospectivo de cohortes. Ámbito. UMI médico-quirúrgica de 14 camas. Pacientes. Fueron 247 pacientes ingresados en UMI más de 24 h, con un seguimiento de 6 meses. Se excluyó a los pacientes con síndrome coronario agudo y los que ingresaban solamente para seguimiento. Intervención. Se realizó una encuesta de CVRS desarrollada por el grupo Proyecto para el Análisis Epidemiológico del Enfermo Crítico sobre su estado previo y a los 6 meses del alta de la UMI. Resultados. La CVRS se deteriora pasando de una mediana de 3 puntos a 6 (p < 0,001). El análisis multivariable muestra menor deterioro en la CVRS en pacientes con antecedentes registrados por el APAChE II (coeficiente de regresión [CR] = -1,4; intervalo de confianza [IC] del 95%, -2,5 a -0,2; p = 0,02) o una CVRS ≥ 10 puntos (CR = -4,4; IC del 95%, -5,9 a -2,8; p < 0,001) y mayor deterioro en pacientes politraumatizados (CR = 1,9; IC del 95%, 0,6-3,3; p < 0,01), con insuficiencia renal (CR = 3,9; IC del 95%, 1,9-5,9; p < 0,001) o estancia en UMI > 10 días (CR = 1,9; IC del 95%, 0,6-3,2; p = 0,004). Conclusiones. La mayoría de los pacientes muestran un deterioro de la CVRS. Los pacientes con enfermedades crónicas o con peor CVRS previa que han sobrevivido a los 6 meses muestran menor deterioro que los politraumatizados o con insuficiencia renal o estancias prolongadas en UMI (AU)

Objective. To determine the changes in the health-related quality of life (hRQOL) six months after discharge from the ICU and the conditions associated to them. Design. A prospective cohort study. Setting. 14 beds medical-surgical intensive care unit (ICU). Patients. A total of 247 patients admitted to our ICU for more than 24 hours with a follow-up of 6 months were study. Those admitted with acute coronary syndrome or for monitoring purposes were excluded. Intervention. A quality of life survey was conducted using the score developed by the PAEEC group (project of the epidemiological analysis of critical illness) to assess hRQOL before ICU admission and 6 months after discharge. Results. The hRQOL deteriorated, going from a median value of 3 to 6 (p < 0.001). The multivariate analysis showed less deterioration of hRQOL in patients with chronic health conditions registered on the APAChE-II score (regression coefficient [RC] = -1.4; 95% CI, -2.5 to -0.2; p < 0.02) and in those with a hRQOL ≥ 10 points (RC = -4,4; 95% CI, -5.9 to -2.8; p < 0.001). There was more deterioration in polytraumatized patients (RC = 1.9; 95% CI, 0.6-3.3; p = 0.01) or with renal failure (RC = 3.9; 95% CI, 1.9-5.9; p < 0.001) or in those with a stay duration longer than 10 days (RC = 1.9; 95% CI, 0.6-3.2; p < 0.001). Conclusions. Most patients experience deterioration of hRQOL. Patients with chronic diseases or with worst previous hRQOL who survive 6 months experience less deterioration of hRQOL than those who are polytraumatized or have renal failure or a longer ICU stay (AU)

[Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes]. / Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos.

OBJECTIVES: To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. PATIENT AND METHOD: Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. RESULTS: A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). CONCLUSIONS: Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD.

Enfermedad pulmonar obstructiva crónica en hospitalización a domicilio. Estudio de 522 casos / Chronic obstructive pulmonary disease in the setting of hospital at home. Study of 522 episodes

Objetivos. Analizar la efectividad, situación respiratoria, servicios de procedencia, causas de reingreso y evolución de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) agudizada en una Unidad de Hospitalización a Domicilio (HaD). Pacientes y método. Estudio de pacientes con EPOC agudizada atendidos en la Unidad de HaD de Vitoria-Gasteiz entre marzo de 1999 y octubre de 2004, donde el ingreso hospitalario es recomendado tras valoración médica. Variables estudiadas: edad, sexo, estancia media, saturación de oxígeno o gasometría arterial, volumen espiratorio forzado en el primer segundo (FEV1) basal, grado de disnea (basal y actual), enfermedades coexistentes, causas de la agudización, servicios de procedencia, utilización de nebulizadores, oxigenoterapia y medicación intravenosa y evolución (altas/ingresos/fallecimientos). Analizamos el número de visitas a Urgencias y los ingresos hospitalarios 3 meses antes y 3 meses después de la intervención de HaD. Resultados. Trescientos dos pacientes que generaron 522 casos con EPOC agudizada fueron aceptados. El 81% eran hombres. La mediana de la estancia fue de 11 días (rango: 1-111). En 396 (76%) casos se dio el alta desde HaD. Ciento once (21%) tuvieron que ser hospitalizados por diferentes causas y 13 (2,5%) fallecieron. El 43 % procedían del Servicio Respiratorio y el 39% de Urgencias. El FEV1 medio fue de 45,4. El 89% de los pacientes tenían disnea 3-4/4 en el momento de ser atendidos. El 9% de los pacientes tuvieron neumonía. Durante los 90 días posteriores al alta por HaD el número de visitas a Urgencias y de ingresos disminuyó significativamente (p < 0,001). Conclusiones. Nuestros datos confirman que la HaD es una buena alternativa a la hospitalización convencional para el manejo de pacientes con EPOC agudizada (AU)

Objectives. To assess the effectiveness, respiratory status, services of origin and outcome of patient with exacerbated COPD attended in Hospital at Home (HaH) regimen. Patient and method. Study of patients with an exacerbated COPD in HaH from Vitoria-Gasteiz, Spain during the period March 1999-October 2004, in whom hospital admission had been recommended after medical assessment. We studied: age, gender, patient's stay, oxygen-saturation or arterial blood gas analysis, FEV1 (basal), dyspnea status (basal and current), coexisting diseases, exacerbation causes, Services of origin, use of home nebulizers and oxygen therapy, intravenous drugs, course (discharges/admissions/deaths). We analyzed the number of visits to the Emergency Department and hospital admissions 90 days before and after discharge from Hospital at home. Results. A total of 302 patients who generated 522 cases with exacerbated COPD were accepted, 81% of whom are men. Means stay was 11 days (0-111). Three hundred ninety six (76%) of the cases were discharge from HaH, 111 (21%) had to be hospitalized for different reasons, on 13 (2.5%) died. Of these, 43% came from the Respiratory Department and 39% from the Emergency one. Mean FEV1 was 45.4. A total of 89% of the patients had dyspnea 4/4 and 34% 3/4 when seen and 9% of the patients had pneumonia. During the 90 days following discharge from Hospital at Home, the number of visits to the Emergency Department and the rate of hospital admissions decreased significantly (p < 0.001). Conclusions. Our data confirm that Hospital at Home is a good alternative to conventional hospital admission for the management of patients with exaxerbated COPD (AU)

Evaluación de una experiencia comunitaria de intervención de ayuda en duelo / Evaluation of a community experience intervening to help with grief

No disponible

No disponible

Factores pronósticos de mortalidad en pacientes con enfermedad pulmonar obstructiva crónica tras su ingreso en una Unidad de Medicina Intensiva. El papel de la calidad de vida / Mortality prognostic factors in patients with chronic obstructive pulmonary disease after their admission in an Intensive Care Unit The role of quality of life

Objetivo. Analizar la asociación entre calidad de vida y mortalidad de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) ingresados en una Unidad de Medicina Intensiva (UMI) y las modificaciones de la calidad de vida a los 6 meses del alta. Diseño. Estudio de cohortes prospectivo de dos años con seguimiento durante un año tras el alta hospitalaria. Ámbito. Una Unidad de Medicina Intensiva. Pacientes. Pacientes con EPOC que ingresan por insuficiencia respiratoria aguda.Intervenciones. Se realizó una encuesta de calidad de vida al ingreso y a los 6 meses del alta. Variables de interés principales. Calidad de vida medida mediante una encuesta validada para enfermos críticos (PAEEC). Mortalidad en UMI, en hospital, a los 6 meses y al año. Resultados. Se incluyeron 91 pacientes. La mortalidad hospitalaria fue del 25,3%, a los 6 meses del 37,4% y al año del 45,5%. El análisis multivariante mostró que la mortalidad hospitalaria se asociaba con APACHE II > 18 (odds ratio 3,7; IC 95%: 1,1-12,2), calidad de vida previa al ingreso > 6 puntos (odds ratio 7,1; IC 95%: 2,1-24,1), y edad > 70 años (odds ratio 4,3; IC 95%: 1,3-14,2). A los 6 meses y al año sólo se asocia de forma independiente con la mortalidad la calidad de vida previa al ingreso. A los 6 meses, la calidad de vida de los supervivientes empeoraba de manera global (8,02 ± 4,85 frente a 5,57 ± 3,39, p = 0,001), así como en las actividades fisiológicas básicas, las actividades de la vida diaria y el estado emocional. Conclusiones. La calidad de vida previa se asocia a la mortalidad hospitalaria, a los 6 meses y al año del alta. La mitad de los pacientes sobrevive al año y son autónomos para sus necesidades básicas

Objective. To analyze the association between quality of life and mortality in patients with chronic obstructive pulmonary disease (COPD) cared in an Intensive Care Unit (ICU), and to determine the modifications of the quality of life at 6 months of discharge. Design. Prospective cohort study with 2 years duration and 1 year follow-up after hospital discharge. Context. An Intensive Care Unit. Patients. Patients with COPD admitted because of respiratory insufficiency. Interventions. A survey of quality of life was conducted at admission and at 6 months of discharge. Primary endpoints. Quality of life measured through a survey validated for critically ill patients (PAEEC). Mortality in ICU, in hospital, at 6 months, and per year. Results. Ninety one patients were included. Hospital mortality was 25.3%, at 6 months was 37.4%, and annual mortality 45.5%. Multivariate analysis showed that hospital mortality was associated with APACHE II scoring > 18 (odds ratio 3.7; CI 95%: 1.1-12.2), quality of life prior to admission > 6 points (odds ratio 7.1; CI 95%: 2.1-24.1), and age > 70 years (odds ratio 4.3; CI 95%: 1.3-14.2). At 6 months and annually only quality of life is independently associated with mortality prior to admission. At 6 months, the quality of life of survivors worsened globally (8.02 ± 4.85 versus 5.57 ± 3.39, p = 0.001), as well as in with regard to basic physiological activities, daily life activities, and emotional stress. Conclusions. Previous quality of life is associated with hospital mortality, with mortality at 6 months after discharge, and with mortality at 1 year after discharge. Half of patients survive at 1 year and can carry out autonomously their daily life activities

[Effectiveness of the protocols on cardiovascular risks in the Basque Country]. / Efectividad de los protocolos sobre riesgos cardiovasculares en el País Vasco.

OBJECTIVES: To find the effectiveness of clinical protocols in detecting and monitoring the most important cardiovascular risk factors: tobacco dependency, high blood pressure, hyperlipaemia and diabetes mellitus. DESIGN: Cross-sectional descriptive study. SETTING: Primary care centres in the Basque Country. PARTICIPANTS: 1485 clinical histories of users aged between 40 and 75 who had attended for consultation over the previous two years, registered with general practitioners in the Basque Country who normally use clinical histories. MEASUREMENTS AND MAIN RESULTS: A questionnaire was sent to the people in charge of the 103 hierarchically organised centres requesting information on the use of protocols to detect and monitor the problems studied, and copies of protocols were requested. 77 centres (76%) replied and 66 sent 170 protocols. 990 clinical histories of doctors who used the four protocols and 495 of doctors who used none were analysed. These clinical histories belonged to lists of 45 doctors from 22 centres, chosen at random and stratified by whether their centre is registered with the PAPPS (preventive programme) or is a family and community medicine teaching centre. The centres using protocols were better at detecting tobacco dependency (24.6% vs 11.9%--p < 0.0005), hyperlipaemia (61.8% vs 53.1%--p < 0.001) and diabetes mellitus (75% vs 66.1%--p < 0.0005). The difference was less in the case of high blood pressure: 56.8% vs 52.1% (p = 0.097). No differences in quality in the monitoring of these problems were found. CONCLUSIONS: The use of cardiovascular risk protocols by primary care centres is related to an improvement in the quality of cardiovascular risk detection, although not of its control.

Análisis de calidad de las guías de práctica clínica sobre riesgos cardiovasculares en el país vasco y propuesta para su evaluación / Analysis of the quality of guidelines to clinical practice on cardiovascular risk in the basque country and proposal for their evaluation

Objetivos. Conocer la implantación y calidad de las guías de práctica clínica (GPC) para el manejo de los riesgos cardiovasculares más importantes: tabaquismo, hipertensión arterial, hiperlipemia y diabetes mellitus. Elaboración de un modelo para evaluar la calidad de las GPC en atención primaria. Diseño. Estudio descriptivo, transversal. Emplazamiento. Los centros de atención primaria del País Vasco. Participantes. Un total de 170 GPC utilizadas actualmente para el manejo de los 4 riesgos cardiovasculares referidos. Mediciones y resultados. Se solicitó información sobre el uso de GPC y se pidieron copias de las utilizadas a los responsables de los 103 centros jerarquizados. Contestaron 77 centros (76 por ciento) y 66 declararon el uso de alguna de ellas. Se recibió un total de 170 GPC. A partir de propuestas previas no específicas para la atención primaria, se elaboraron 21 criterios de calidad de las GPC agrupados en 6 bloques. El mayor nivel de calidad se observó en el bloque correspondiente a la claridad del procedimiento clínico, con un cumplimiento del 63 por ciento de las GPC, seguido por la descripción general (54 por ciento) y la evaluación y medida del impacto (30 por ciento). Los bloques con peor nivel de cumplimiento fueron la identificación de las personas involucradas en su diseño (23 por ciento), la evidencia de sus recomendaciones (19 por ciento) y las condiciones de aplicación (4 por ciento). Conclusiones. Se propone un modelo para la evaluación de la calidad de las GPC. Se aprecian importantes deficiencias en su calidad, más acusadas en aspectos tan claves como el soporte bibliográfico de sus recomendaciones, la previsión de condiciones para su aplicación y la identificación de autores y revisores (AU)

Efectividad de los protocolos sobre riesgos cardiovasculares en el País Vasco / Effectiveness of the protocols on cardiovascular risks in the basque country

Objetivos. Conocer la efectividad de los protocolos clínicos para la detección y control de los riesgos cardiovasculares más importantes: tabaquismo, hipertensión arterial, hiperlipemia y diabetes mellitus. Diseño. Estudio descriptivo. transversal. Emplazamiento. Centros de atención primaria del País Vasco. Participantes. Un total de 1.485 historias clínicasde usuarios de 40-75 años que han acudido a consulta en los 2 últimos años, adscritos a médicos de atención primaria del País Vasco, que utilizan habitualmente la historia clínica. Mediciones y resultados. Se envió encuesta a responsables de los 103 centros jerarquizados, solicitando información sobre uso de protocolos para la detección y control de los problemas estudiados y se pidieron copias. Contestaron 77 centros (76 por ciento) y 66 remitieron 170 protocolos. Se analizaron 990 historias clínicas de médicos que utilizan los 4 protocolos y 495 de médicos que no usan ninguno, pertenecientes a 45 médicos de 22 centros distintos, seleccionadas de forma aleatoria y estratificada según su centro esté adscrito al PAPPS o sea docente para MFyC. Los centros que usan protocolos presentan una mayor calidad en detección del tabaquismo, 24,6 frente a 11,9 por ciento (p < 0,0005); hiperlipemia, 61,8 frente a 53,1 por ciento (p < 0,001), y diabetes mellitus, 75,0 frente a 66,1 por ciento (p < 0,0005). La diferencia es menor para hipertensión arterial, 56,8 frente 52,1 por ciento (p = 0,097). No se encuentran diferencias de calidad en el control de estos problemas. Conclusiones. La utilización de protocolos de riesgos cardiovasculares por los centros de atención primaria se relaciona con una mejora en la calidad de su detección, aunque no con la de su control (AU)

[Quality analysis of clinical practice guidelines on cardiovascular risks in the Basque country and a proposal for their evaluacion]. / Análisis de calidad de las guías de práctica clínica sobre riesgos cardiovasculares en el País Vasco y propuesta para su evaluación.

OBJECTIVES: To find the implantation and quality of clinical practice guidelines (CPG) to manage the major cardiovascular risks: tobacco dependency, hypertension, hyperlipaemia and diabetes mellitus. To work out a model to evaluate the quality of the CPG in primary care. DESIGN: Cross-sectional descriptive study. SETTING: The primary care centres of the Basque Country. PARTICIPANTS: 170 CPG used at present to manage the four mentioned cardiovascular risks. MEASUREMENTS AND MAIN RESULTS: Information was requested on the use of CPG and copies of their guidelines were requested from those in charge of 103 ranked centres. 77 centres replied (76%), of which 66 said they used one of them. A total of 170 CPG were received. On the basis of non-specific prior proposals for primary care, 21 quality criteria for the CPG, grouped in 6 blocks, were drawn up. Top quality was found in the block for clarity of clinical procedure with 63% compliance with the CPG, followed by general description (54%), and evaluation and measurement of impact (30%). The blocks with worst compliance were identification of people involved in their design (23%), evidence of their recommendations (19%) and conditions of application (4%). CONCLUSIONS: A model was proposed to evaluate the quality of the CPG. Major deficiencies in quality were found. These were most marked in key aspects such as bibliographic support for their recommendations, envisaging of conditions for application and identification of authors and reviewers.

[White coat and non-dipper hypertension in patients recently diagnosed with mild hypertension]. / Hipertensión de bata blanca e hipertensos non-dippers en pacientes recientemente diagnosticados de hipertensión arterial ligera.

OBJECTIVE: To calculate the prevalence of white coat hypertension (WCH) in patients recently diagnosed with light hypertension. To compare their demographic features, cardiovascular risk factors, and the level of early organic effect of WCH versus sustained hypertension, and dippers versus non-dippers. DESIGN: Descriptive, crossover study. SETTING: Five urban health centres. PATIENTS: 238 people between 18 and 65 were chosen. After screening, they were diagnosed with light (1993 WHO criteria) or essential hypertension. MEASUREMENTS AND MAIN RESULTS: Patients received: 24-hour out-patient control of blood pressure (BP), analysis, back of eye and electrocardiogram. WCH was defined as mean daily BP < 139/88 mmHg and mean night-time BP < 123/74 mmHg. Non-dippers were those patients whose mean night-time BP went down from the daytime BP by less than 10%. 39.5% had WCH (33.3-45.7). This was associated with women (49.5%), with lower casual systolic and diastolic BP and with isolated systolic hypertension, p < 0.05. Risk of WCH was 2.14 times greater in women (95% CI, 1.24-3.70). There were no significant differences in the cardiovascular risk or morbidity profile between WCH and sustained HT, or between dippers and non-dippers. CONCLUSIONS: WCH is common in patients recently diagnosed with both light and essential hypertension. This makes us think that the use of primary care out-patient monitoring of BP could be efficient in this type of patient. The absence of significant differences between WCH and sustained hypertension, or between dippers and non-dippers, may be due to their hypertension being recent.

[Coinfection by mycobacteria in HIV-positive patients]. / Coinfección por micobacterias en pacientes HIV-positivos.

BACKGROUND: The aim of this study was to describe the clinical characteristics and therapeutic management of coinfection by mycobacteria in the authors hospital. METHODS: Two cases of coinfection detected in mixed cultures in agar 7H11 or simultaneous positive cultures in several evaluable clinical samples (blood cultures for MAI and M. kansasii and sputum or stools for M. tuberculosis). RESULTS: One coinfection by MAI and M. tuberculosis and another by MAI and M. kansasii in two severely immunosuppressed HIV positive patients with less than 0.010 CD4 lymphocytes/10(9)/l. The clinical manifestations were unspecific, with fever and deterioration of the general state predominating over the 30-45 days of evolution. One of the patients improved with treatment which, in both cases, included a macrolide. Survival was very short and death was by intercurrent causes. CONCLUSIONS: For the diagnostic of coinfection in severely immunosuppressed patients multiple organic samples should be taken and appropriately processed to detect the mixed cultures or the presence of different mycobacteria in different samples from the same patients. Although the diagnosis of the species is fundamental, the empiric treatment of a disease by mycobacteria in severely immunosuppressed patients should include at least: ethambutol and clarithromycin or azithromycin in addition to other first line tuberculostatic drugs until definitive identification.

[Barriers to verbal communication and consumer satisfaction with consultations in general medicine]. / Barreras a la communicación verbal y satisfacción del usuario en las consultas de Medicina General.

With the objective of knowing the barriers to verbal communication experienced by general practice users, and their satisfaction with the information received, a sample of 1553 adults (> 14 years old), users of the Basque Health Service general practice services, was interviewed. A questionnaire of 13 questions, administered after the consultation, was employed. The most frequently experienced barrier was the lack of written information, that affected to a 77.7% of those interviewed. This percentage is greater (p < 0.005) among those visiting traditional doctors (81.9%), than among those enrolled with primary care teams (72.4%) or rural doctors (70.0%). Those who were given written information left out the consultation more satisfied than the others (p < 0.001). The provision of written information seems to be related to the user's satisfaction. It is advised to modify the doctors' attitude towards the communicative process with their patients.