Utilización de heparinas de bajo peso molecular en pacientes hospitalizados en Medicina Interna / Use of low molecular heparins in inpatients of Internal Medicine

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Trombosis venosa profunda y cáncer: actitud diagnóstica / Deep venous thrombosis and cancer

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Utilización de supresores de la secreción ácida en pacientes hospitalizados / Use of acid-suppresive medications in hospitalized patients

Introducción: Los fármacos supresores de la acidez gástrica son frecuentemente utilizados, pero algunos estudios evidencian su mal uso, sobretodo en la profilaxis de la úlcera de estrés en pacientes con bajo riesgo. Este estudio evalúa su frecuencia y utilización de en pacientes hospitalizados en una planta de Medicina Interna. Material y métodos: Revisión aleatoria y retrospectiva de 209 historias clínicas de 661 pacientes ingresados durante el año 2000 en el servicio de Medicina Interna V Hospital General Universitario Gregorio Marañón (Cantoblanco). Definiciones: Utilización: Al menos una vez, a cualquier dosis y de cualquier fármaco antiácido. Indicación correcta: Criterios endoscópicos: Ulcera activa, Esofagitis y Gastritis. Criterios clínicos: síntomas de reflujo, dispepsia, mantenimiento por proceso previo, hemorragia digestiva alta activa, ingesta de antiinflamatorios no esteroideos, profilaxis de úlcera de estrés en pacientes con alto riesgo. Indicación incorrecta: Cualquier otra utilización no incluida anteriormente. Resultados: De 209 pacientes, 75,1 por ciento (157) los utilizaron, edad media de 76 años (23-99), mujeres 89 (56,7 por ciento) y hombres 68 (43,3 por ciento).Los diagnósticos más frecuentes al ingreso: ICC 34 (21,7 por ciento), Neumonía 26 (16,6 por ciento), ITU 24 (15,3 por ciento) y EPOC 18 (11,5 por ciento). La utilización en planta fue de 84,7 por ciento (133), con uso incorrecto 72,2 por ciento (96), la causa de uso incorrecto "sin razones" en 52,1 por ciento(50) y la medicación inhibidores bomba 46,9 por ciento (45). Conclusiones: Este estudio evidencia una alta utilización de fármacos inhibidores de la secreción ácida, de manera incorrecta en pacientes hospitalizados (AU)

Introduction: The acid-suppressive medications are used frequently in hospitalized patients, but some studies suggests that their are overused, especially in the treatment of stress ulcer prophylaxis in low-risk patients. This research determine the frequency of use and indications of acid-suppressive medications in hospitalized patients in a internal medical service. Materials and methods: A at random and retrospective revision of 209 medical records of 661 hospitalized patients during the year 2000 in the V Internal Medical Service of the General University Hospital of Gregorio Marañón (Cantoblanco). Definitions: Use: any prescription of an acid-suppressive medication, regardless of dosage regimen, in which the patient received at least one dose. Appropriated indication: endoscopical criteria: treatment of active ulcer disease, esophagitis or gastritis. Medical criteria: symptomatic gastroesophageal reflux, dyspepsia, prolonging of previous treatment, as a part of a treatment regimen for H. pylori, relief of dyspepsia caused by nonsteroidal anti-inflammatory drugs, stress ulcer prophylaxis in high risk patients. Inappropriate indication: any other uses were considered not indicated. Results: Of the 209 patients, a total of 157 (75,1%) received acid-suppressive therapy, average age 76 years old, 89 women (56,7%) and 68 men (43,3%). The admitting diagnoses for the admission were: CHF 34 (21,7%), Pneumonia ( 16,6%), UTI (15,3%) y COPD 18 (11,5%). The use in hospital ward was 84,7% (133), with inappropriate use 72,2% (96), the cause of prescription "no reason" 52,1% (50), and received proton pump inhibitors 46, 9% (45). Conclusions: This study show a high frequency of incorrect use of acid-suppressive medications in hospitalized patients (AU)

[Use of acid-suppressive medications in hospitalized patients]. / Utilización de supresores de la secreción ácida en pacientes hospitalizados.

INTRODUCTION: The acid-suppressive medications are used frequently in hospitalized patients, but some studies suggests that their are overused, especially in the treatment of stress ulcer prophylaxis in low-risk patients. This research determine the frequency of use and indications of acid-suppressive medications in hospitalized patients in a internal medical service. MATERIALS AND METHODS: A at random and retrospective revision of 209 medical records of 661 hospitalized patients during the year 2000 in the V Internal Medical Service of the General University Hospital of Gregorio Marañón (Cantoblanco). DEFINITIONS: Use: any prescription of an acid-suppressive medication, regardless of dosage regimen, in which the patient received at least one dose. Appropriated indication: endoscopical criteria: treatment of active ulcer disease, esophagitis or gastritis. Medical criteria: symptomatic gastroesophageal reflux, dyspepsia, prolonging of previous treatment, as a part of a treatment regimen for H. pylori, relief of dyspepsia caused by nonsteroidal anti-inflammatory drugs, stress ulcer prophylaxis in high risk patients. Inappropriate indication: any other uses were considered not indicated. RESULTS: Of the 209 patients, a total of 157 (75.1%) received acid-suppressive therapy, average age 76 years old, 89 women (56.7%) and 68 men (43.3%). The admitting diagnoses for the admission were: CHF 34 (21.7%), Pneumonia (16.6%), UTI (15.3%) y COPD 18 (11.5%). The use in hospital ward was 84.7% (133), with inappropriate use 72.2% (96), the cause of prescription "no reason" 52.1% (50), and received proton pump inhibitors 46.9% (45). CONCLUSIONS: This study show a high frequency of incorrect use of acid-suppressive medications in hospitalized patients.

[Infection by Strongyloides stercoralis in the county of Safor, Spain]. / Infección por Strongyloides stercoralis en la comarca de La Safor (Comunidad Valenciana).

BACKGROUND: Strongyloides stercoralis is an endemic nematode in tropical and subtropical regions, but almost unknown in Spain. PATIENTS AND METHODS: In order to know some epidemiological, clinical and analytic features of this infection in our area (La Safor, Valencia), we performed a prospective study for 19 months. Through the search for the parasite in feces of patients with eosinophilia, we identified 37 subjects who were studied at diagnosis and 4 months later. RESULTS: Thirty-three patients (89%) were currently, or had been agricultural workers, and thirty had worked barefooted and/or had drunk contaminated irrigation water. Twenty-three patients (62%) had a chronic or immunosuppressive diseases, and two of them on steroid treatment, developed a disseminated strongyloidiasis. Thirteen patients (35%) were asymptomatic; the rest had clinical manifestations attributed S. stercoralis, mainly digestive. Two of the patients with disseminated strongyloidiasis also had concomitant bacterial infections by Streptococcus bovis, Streptococcus faecalis and Enterobacter sp. At diagnosis, besides eosinophilia, 86.5% had raised levels of IgE. Four months later treatment, the number of eosinophils was normal and IgE levels significantly decreased. The diagnostic yield of parasitic study of feces was increased with the number of samples examined. Thiabendazole achieved erradication of the parasite in 35 patients, and the other two died because of disseminated strongyloidiasis. CONCLUSIONS: The presence of eosinophilia in patients from rural areas with subtropical climate should raise suspicion about infection by S. stercoralis, which, although sometimes is asymptomatic, may cause systemic bacterial infections in cases of hyperinfestation, specially when glucocorticoid treatment is given.

[Strongyloides stercoralis infection in patients with bronchial obstructive pathology]. / Infección por Strongyloides stercoralis en pacientes con patología bronquial obstructiva.

Strongyloides stercoralis infection was hardly seen in Spain until a few years ago but has recently been shown to be fairly common in some geographic areas. In the respiratory tract this germ can cause acute bronchospasms that make diagnosis difficult, particularly in patients with underlying bronchial disease. To determine if curing S. stercoralis infection is accompanied by clinical and functional improvement in patients with bronchial obstruction, we studied the evolution of 22 infected patients: 11 with no bronchopulmonary disease and 11 with chronic airway obstruction or asthma. The following variables were assessed in both groups at the moment of diagnosis of infection and four months after cure: levels of eosinophils and total serum IgE, respiratory symptoms, steroid doses and spirometric parameters. After four months we observed a significant decrease in eosinophil (16 versus 5%) and IgE (1,600 versus 770 IU/ml) levels in both groups. The number of bronchospasms and daily steroid doses required decreased in the group with bronchial disease. No significant differences were seen in spirometric parameters, however. The improvement in respiratory symptoms, blood parameters and need for medication leads us to believe that airway inflammation decreases after the infection has been eradicated, in spite of the lack of improvement in bronchial obstruction.

[Severe self-limiting hypersensitivity reaction after immunotherapy with intravesical BCG]. / Severa reacción de hipersensibilidad autolimitada tras inmunoterapia con BCG intravesical.

We present the case of a 67-years-old patient diagnosed of superficial vesical transitional carcinoma which, under immunotherapy with intravesical BCG, developed a severe hypersensitivity reaction with spontaneous resolution. We describe several adverse reactions after the administration of intravesical BCG, as well as its diagnostic and therapeutic problems, especially in the cases of hypersensitivity.

[Meningeal myelomatosis as an exclusive form of recurrence in a case of IgA-lambda myeloma in complete systemic remission]. / Mielomatosis meníngea como forma exclusiva de recaída en un caso de mieloma IgA-lambda en remisión completa sistémica.

Meningeal myelomatosis is an extremely rare clinical presentation generally associated to terminal states of the disease and is more frequent in the presence of peripheric plasmocytosis or leukemia of the plasmatic cells. Diagnosis requires its demonstration in the cephalorhachidian liquid and its monoclonal secretion. A case of relapse of meningeal myelomatosis in a patient with multiple IgA-lambda myeloma is presented in which the systemic disease fulfilled the criteria for complete remission.