A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP).

Little is known about the main features of the emergent population of PP. Our objective was to determine the clinical, care and social characteristics of a multi-institutional population of PP, by means of a cross-sectional study including a reference population of hospital-based PP from 36 hospitals. The main clinical, functional, mental and social features and their associated factors were assessed: 1632 PP (53% males, mean age 77.9±9.8 years) were included. An informal caregiver was required by 52% (78% of caregivers were close female relatives). The mean inclusion criteria (Cat): were 2.7±0.8 (49.5% presented ≥3 Cat). The most frequent inclusion Cat were heart (77.5%), lung (45.6%), neurological (38.2%), and kidney diseases (32.2%), whereas the mean of other comorbidities was 4.5±2.7 per PP. The mean Charlson comorbidity index (CCI) was 4; 47.6%, and 52.4% presented dyspnea ≥3 on the NYHA, and on the MRC, respectively; nearly 19% required home oxygen therapy, 19% had suffered >1 fall in previous year, and 11% suffered an active neoplasia. The mean hospital admissions in last 12/3 months, and chronically prescribed drugs were 2/1, and 8±3, respectively. More than 70% presented obesity, while 60% had hypoalbuminemia. The basal/inclusion Barthel index (BI) score was 69±31/58±34 (BI score<60 was present in 31.5%/44%, respectively); and the mean Pfeiffer score was 2.94±3.2 (43% answered with ≥3 errors). More than half of the subjects were at risk or already had established social problems. This emergent population is considerably homogeneous, highly complex, clinically vulnerable, functionally impaired, dependent on caregivers and socially fragile. They need to receive more attention in clinical research and more support in health interventions based on comprehensive attention and continuity of care.

Mujer de 64 años con nódulo pulmonar e hipertensión arterial / No disponible

No disponible

Leiomiosarcoma primario pulmonar de progresión lenta / Slow progression primary pulmonar leiomiosarcoma

No disponible

Edema de extremidad superio como forma de presentación de polimiositis / Limited edema to an upper extremity like a form or presentation of polymyositis

No disponible

[Side effects of antiretroviral therapy. Fisiopathology, clinical manifestations and treatment]. / Efectos adversos de los fármacos antirretrovirales. Fisiopatología, manifestaciones clínicas y tratamiento.

The suppression of plasma viral loads in HIV infected patients to less than the limit of quantification of the most sensitive commercially available assays and the coincident improvement in CD4 T cell counts is associated with a decrease in the risk of new opportunistic infections in this patients. The descent at the morbibility and mortality is specialy important since the introduction in 1996 the hard activity antirretroviral therapy (HAART). However, prolonged treatment with combination regimens can be difficult to sustain because of problems with adherence and toxic effects. All antiretroviral drugs can have both short-term and long-term adverse events. The risk of specific side effects varies acording to specific drug, drug class and even, individual susceptibility. A better understanding of the adverse effects of antiretroviral agents is of interest to try to optimize therapy in HIV infected patients.

Efectos adversos de los fármacos antirretrovirales. Fisiopatología, manifestaciones clínicas y tratamiento / Side effect of antiretroviral therapy. Fisiopathology, clinical manifestations and treatment

La disminución plasmática de la carga vírica de pacientes con infección por el VIH, por debajo de los límites de cuantificación de las técnicas más sensibles disponibles en la actualidad, junto con el aumento del número de linfocitos CD4, se ha asociado con un descenso en el riesgo de padecer enfermedades oportunistas en estos pacientes. El descenso de la morbilidad y la mortalidad, es especialmente importante desde la introducción en 1996, del tratamiento antirretrovírico de gran actividad (TARGA). Sin embargo, el tratamiento prolongado con estas combinaciones de fármacos puede ser dificultosos debido a los problemas que generan la adherencia y los efectos adversos. Todos los antirretrovirales pueden producir efectos secundarios a corto y largo plazo. El riesgo de efectos adversos específicos varía según el fármaco, la clase a la que pertenece e incluso la susceptibilidad individual. El mejor conocimiento de los efectos adversos de los fármacos antirretrovirales es necesario para intentar optimizar el tratamiento en pacientes infectados por el VIH

The suppression of plasma viral loads in HIV infected patients to less than the limit of quantification of the most sensitive commercially available assays and the coincident improvement in CD4 T cell counts is associated with a decrease in the risk of new opportunistic infections in this patients. The descent at the morbibility and mortality is specialy important since the introduction in 1996 the hard activity antirretroviral therapy (HAART). However, prolonged treatment with combination regimens can be difficult to sustain because of problems with adherence and toxic effects. All antiretroviral drugs can have both short-term and long-term adverse events. The risk of specific side effects varies acording to specific drug, drug class and even, individual susceptibility. A better understanding of the adverse effects of antiretroviral agents is of interest to try to optimize therapy in HIV infected patients

[Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients]. / Tratamiento de la infección crónica por VHC en pacientes coinfectados por el VIH.

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs' adverse effects and interactions, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon andribavirin, which have improved prior treatments, but the response rate depends on HCV genotype.

Tratamiento de la infección crónica por VHC en pacientes coinfectados por el VIH / Treatment of chronic hepatitis C virus infection in human immunodeficiency virus (HIV) infected patients

El tratamiento de la infección por el virus de la hepatitis C (VHC) en los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH) se ha convertido en un tema de gran importancia, ya que las complicacionesde la hepatopatía son actualmente la primera causa de mortalidad entre el colectivo con infección por el VIH. El objetivo de este trabajo es revisar los datos biológicos y epidemiológicos de la coinfección, y sobre todo las pautas de tratamiento a seguir, valorando las complicaciones producidas por los fármacos utilizados y sus interacciones, e informar de los resultados de los principales estudios realizados. La pauta de tratamiento actualmente aceptada incluye interferón pegilado y ribavirina. Con estos fármacos han mejorado los resultados respecto a pautas previas, aunque la respuesta es variable según el genotipo- VHC que presente el paciente

Treatment of chronic hepatitis C Virus (HCV) infection in human immunodeficiency virus (HIV) infected patients has become a topic of great importance, since the complications of chronic hepatitis are the first one cause of mortality among HIV patients. The aim of this study is to review the biological and epidemiological data in HIV-HCV coinfection, to establish treatment guidelines taking in consideration drugs adverse effects and interations, and to report the results of the main studies carried out. The treatment currently accepted includes pegylate interferon and ribavirin, wich have improved prior treatments, but the respouse rate depends on HCV genotype

Shock hipovolémico como forma de presentación de un tumor ovárico / Hypovolemic shock as a presentation of an ovary tumor

No disponible

Demencias curables, ¿existen realmente? / Reversible dementias, do they exist?

Debido al aumento de la esperanza de vida, la prevalencia de los pacientes con demencia ingresados en las Unidades de Medicina Interna es muy elevada (un 30 por ciento de los mayores de 80 años). La incidencia de las demencias potencialmente reversibles es muy variable dependiendo de las publicaciones consultadas (entre un 10 y 30 por ciento). El objetivo del estudio es saber la incidencia real de estas demencias y cual es el protocolo diagnóstico que se debe seguir para optimizar los recursos. Las conclusiones obtenidas mediante la revisión bibliográfica realizada es que la incidencia de este tipo de demencias es mucho menor que el citado siendo un 1,5-3 por ciento (AU)

[Reversible dementias, do they exist?]. / Demencias curables, ¿existen realmente?

Due to the increase of the life expectancy the prevalence of the patients with dementia in the services of Internal Medicine is very high (30% in the patients with more of 80 years old). The incidence of the potentially reversible dementias is very different in the publications consulted (10-30%). The objective of these study is to know the real incidence of these dementias and which is the best diagnostic protocol to optimize the resources. The conclusions obtained in the bibliographical review it is that the effect of this type of dementias is minor that the mentioned (1.5-3%).

Tromboembolismo pulmonar en un Servicio de Medicina Interna (1992-97) / Pulmonary embolism in the Internal Medicine Service (1992-97)

No disponible

[Tongue tuberculosis as the first expression of the lung process]. / Tuberculosis lingual como primera manifestación de un proceso pulmonar.

Nowadays tuberculosis incidence seems to increase again after past decades fall. This event has been worsen because of the growth of resistances, basically due to patient's failure to comply with scheduled specific therapeutics. Anyway the decrease of tuberculosis leads initially to lowering of extrapulmonary forms, being the mouth cavity one of the most infrequent seat, so that location can be omitted at first glance diagnosis. We report one tongue tuberculosis case, which was the first expression of a lung tuberculosis, and discuss other manifestations within oral cavity and also the problems of some cases, as well as the best treatment.

Pancreatitis aguda como forma de presentación de enfermedad de Crohn / Acute pancreatitis as presentation of Crohn´s disease

No disponible