Reflexiones sobre el infradiagnóstico y la primoinfección por VIH / Reflections on underdiagnosis and primary HIV infection

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Mononeuropatía múltiple por lepra: descripción de un caso con presentación atípica / Mononeuritis multiplex due to leprosy: A case of atypical presentation

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Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad / Adequacy of the admissions and care provided to the patients with community-acquired pneumonia

Objetivo. El objetivo de este estudio es conocer la adecuación de los ingresos hospitalarios por neumonía adquirida en la comunidad (NAC) aplicando la Regla de Clasificación Pronóstica de Fine Modificada y si la atención del paciente se realiza según los indicadores de calidad que la Infection Diseases Society of America (IDSA) recomienda. Pacientes y métodos. Estudio retrospectivo y transversal que analiza la adecuación de ingresos hospitalarios de todos los pacientes atendidos con NAC en el Hospital Clínico Universitario de Valladolid durante el año 2006. A todos los pacientes se les aplicó la Regla de Clasificación Pronóstica de Fine Modificada para evaluar la adecuación de ingresos hospitalarios analizando la comorbilidad asociada, los parámetros de gravedad y los indicadores de calidad. Resultados. Se detectaron 23 casos (6,07%) de NAC que ingresaron de manera inadecuada de los cuales 5 eran clase I (21,7%), 10 clase II (43,4%) y 8 clase III (34,7%). La EPOC (32,5%) y la hipoxemia (36%) fueron la comorbilidad y el factor de riesgo más implicados a la hora de justificar el ingreso de las NAC de bajo riesgo. Se evidenciaron 25 (32,89%) altas inadecuadas desde Urgencias y con respecto a su PSI se encontró: clase I: 2 (8%); clase II: 10 (40%); clase III: 7 (28%); clase IV: 4 (16%); clase V: 0; Fine desconocido: 2. La comorbilidad más implicada en las altas inadecuadas fue la EPOC (10 [40%]). Se realizaron: hemocultivos en 160 casos (42,2%), radiografía de tórax en 379 (100%), gasometría y/o oximetría de pulso en 379 (100%), y determinación de Ag de Streptococcus pneumoniae y Legionella en orina en 14 (87,5%) de los 16 casos de NAC que precisaron ingreso en UCI. Conclusión. La Regla de Clasificación Pronóstica de Fine Modificada puede ser muy útil a la hora de evaluar la adecuación de ingresos y para decidir la necesidad de ingresos hospitalarios por NAC. Destaca la adecuada atención de los pacientes con NAC según los indicadores de calidad establecidos por la IDSA(AU)

Background. The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. Patients and methods. A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. Results. We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. Conclusion. The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out(AU)

[Adequacy of the admissions and care provided to the patients with community-acquired pneumonia]. / Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad.

BACKGROUND: The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. PATIENTS AND METHODS: A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. RESULTS: We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. CONCLUSION: The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out.

Mujer de 26 años con náuseas y distensión abdominal / A 26 years woman with nauseas and abdominal distension

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