[Meningoencephalitis by Listeria in the lupus disease]. / Meningoencefalitis por Listeria en el lupus.

We present a patient with lupus nephropathy of 20 years of evolution in treatment with oral steroids who developed a meningoencephalitis associated to bacteraemia by Listeria monocytogenes. The patient was treated successfully with gentamicin and ampicillin for 6 weeks. Infection by Listeria monocytogenes occurs more frequently in individuals with some form of immunodeficiency like lupus disease, with a mortality around 30%.

Manejo clínico y pronóstico de pacientes mayores supervivientes al infarto de miocardio / Clinical management and prognosis in elderly survivors of myocardial infarction

Introducción: los pacientes de edad avanzada con infarto agudo de miocardio (IAM) presentan elevada morbimortalidad. Nuestro objetivo es conocer el abordaje clínico recibido por el paciente de edad avanzada que sobrevive al IAM en nuestro medio y su pronóstico a corto plazo. Material y métodos: se recogieron datos correspondientes a los pacientes dados de alta tras presentar un IAM. Se comparó el tratamiento clínico y el pronóstico de los pacientes mayores de 70 años con el resto. Se realizó un seguimiento medio de 11,7 meses. Resultados: doscientos nueve pacientes, que se dividieron en 2 grupos según su edad: grupo de jóvenes (111 pacientes = 70 años de edad). No hubo diferencias en el tipo de infarto presentado ni en el tratamiento de revascularización recibido. En los mayores hubo una menor realización de ergometría y de cateterismo. Entre los que se realizó cateterismo, los mayores presentaban un mayor número de arterias coronarias con lesiones graves (1,67 ± 0,9 frente a 1,32 ± 0,9; p = 0,03). El porcentaje de revascularización fue similar. Durante el seguimiento, no se observaron diferencias en la mortalidad (global, 5,7%), ni en la tasa de reingresos o revascularización. Conclusiones: los pacientes mayores que sobreviven a un IAM han sido tratados de forma similar al resto, aunque la realización de ergometría y cateterismo es más baja. Su enfermedad coronaria es más grave y el porcentaje de revascularización en los que se indicó cateterismo, similar al resto. Su pronóstico a corto plazo es bueno

ntroduction: patients of an advanced age who suffer an acute myocardial infarction (AMI) have an elevated risk of morbidity and mortality. Our objective was to identify the clinical management of elderly patients recovering from an AMI in our milieu and their short-term prognosis. Material and methods: data were collected on survivors of an AMI. The clinical management and outcome of patients aged over 70 years was compared with those of patients aged less than 70 years. The mean follow-up was 11.7 months. Results: two hundred and nine patients were divided into two groups according to age: a «younger» group (111 patients aged under 70 years) and an «older» group (98 patients aged 70 and over). There were no differences in the type of infarction or in the type of revascularisation. Fewer ergometries and catheterisations were performed in the older patients. Among those who underwent catheterisation, the older group presented a greater number of coronary arteries with severe lesions (1.67 ± 0.9 as opposed to 1.32 ± 0.9, p = 0.03) than the younger group. The percentage of revascularisation was similar in both groups. During the follow-up, no differences in mortality (overall mortality was 5.7%), the rate of re-admissions or revascularisation were observed. Conclusions: patients of an advanced age surviving an AMI were treated similarly to all other patients, although they underwent less ergometry and cardiac catheterisation. Their coronary disease is more severe and the percentage of revascularisation for which catheterisation was indicated was similar to that in younger patients. Their short-term prognosis was good

Meningoencefalitis por Listeria en el lupus / Meningoencephalitis by Listeria in the lupus disease

Presentamos un caso de una paciente con nefropatía lúpica de 20 años de evolución en tratamiento con esteroides que desarrolló una meningoencefalitis asociada a bacteriemia por Listeria monocytogenes. La paciente recibió tratamiento antibiótico con ampicilina y gentamicina durante 6 semanas con excelentes resultados. La infección por Listeria monocytogenes afecta predominantemente a pacientes con cierto grado de inmunosupresión, como pacientes con lupus eritematoso sistémico, con una mortalidad alrededor del 30%

We present a patient with lupus nephropathy of 20 years of evolution in treatment with oral steroids who developed a meningoencephalitis associated to bacteraemia by Listeria monocytogenes. The patient was treated successfully with gentamicin and ampicillin for 6 weeks. Infection by Listeria monocytogenes occurs more frequently in individuals with some form of immunodeficiency like lupus disease , with a mortality around 30%