Predictive models for all-cause and cardiovascular mortality in type 2 diabetic inpatients. A cohort study.

BACKGROUND: Many authors have analysed premature mortality in cohorts of type 2 diabetic patients, but no analyses have assessed mortality in hospitalised diabetic patients. AIM: To construct predictive models to estimate the likelihood of all-cause mortality and cardiovascular mortality in type 2 diabetic inpatients. DESIGN: Cohort study with follow-up from 2010 to 2014. METHODS: We evaluated mortality in a randomly selected cohort of 112 type 2 diabetic inpatients at the Hospital of Elda (Spain) in 2010-2012. OUTCOMES: all-cause mortality and cardiovascular mortality during the follow-up. Other variables: gender, age, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidemia, insulin, pills, smoking, walking, baseline blood glucose and creatinine. Predictive tables with risk groups were constructed to estimate the likelihood of all-cause mortality and cardiovascular mortality. Calculations were made of the area under the ROC curve (AUC). RESULTS: During the follow-up, 52 inpatients died (46.4%, 95% CI, confidence interval: 37.2-55.7%), 22 because of cardiovascular causes (19.6%, 95% CI: 12.3-27.0%). The mean follow-up time was 2.7 ± 1.5 years. The AUC for the all-cause mortality model was 0.84 (95% CI: 0.77-0.92, p < 0.001). Associated parameters: pills, smoking, walking, gender, insulin and age. The AUC for the cardiovascular mortality model was 0.79 (95% CI: 0.67-0.91, p < 0.001). Associated parameters: age, pills, walking, smoking, depression and insulin. CONCLUSIONS: This study provides tools to predict premature mortality in type 2 diabetic inpatients. However, before their general application they require joint validation by the internal medicine unit, emergency department, primary healthcare unit and endocrinology service to enable better prediction of the prognosis and more adequate decision-taking.

[Characterization of Haemophilus influenzae strains using sugar fermentation]. / Caracterización de cepas de Haemophilus influenzae mediante fermentación de azúcares.

64 Haemophilus influenzae strains circulating in Havana City during a year were characterized by the carbohydrate fermentation method for the first time in Cuba. The fermentative pattern D was the most frequently found. Patterns D and G together were 72% of the total of strains studied. The combination of the carbohydrate fermentation with serotyping and biotyping allowed a greater differentiation of strains (14 groups). Patterns A, B, C and F appeared in children over 6 months of age, and pattern G in the group from 6 to 18. Patterns D and G predominated in the bacterial meningoencephalitis. A higher heterogeneity was observed among the strains isolated from acute respiratory infections. Some of the advantages of the Haemophilus influenzae strains subtyping method are stressed, such as: simplicity, easiness to be applied and interpreted, and the fact that it is not necessary a qualified personnel or a specialized laboratory for its implementation.

[Severe metabolic alkalosis during hemodialysis]. / Alcalosis metabólica severa durante la hemodiálisis.

Severe metabolic alkalosis in a patient while being hemodialysed with dialysate of bicarbonate is presented. The evolution was satisfactory after a session of hemodialysis with a bath of acetate. Disorders in the acid-base balance which appear following dialytic technics more complex each time are discussed.

[Systemic calciphylaxis and acquired perforating disease in a uremic patient]. / Calcifilaxis sistémica y enfermedad perforante adquirida en paciente urémico.

We show the case of a patient suffering from a chronic renal failure in hemodialysis. He had a ischemic necrosis that was quickly progressive in his fingers and toes. It was necessary to amputate them. Diffuse vascular calcifications were recorded so radiologically than pathologically. PTH and phosphocalcic product were raised. Parathyroidectomy was practised with a quick initial improvement but immediately new distal ischemic lesions and keratotic papules with histologic perforation, that became necrosed, appeared in his buttocks and inferior extremities. The coexistence of acquired perforating disease and calciphylaxis in uremic patients has not been reported until now.

Cimetidina en el tratamiento del sangramiento digestivo alto / Cimetidine in the treatment of upper digestive bleeding

Presentamos 2 grupos de pacientes sometidos a tratamiento convencional más cimetidina, para comparar los resultados obtenidos con cada tratamiento en cuanto a curas, fracasos y mortalidad, y la relación existente entre éstos y otras variables como estancia, edad, sexo, cuantía y causa de sangramiento, y tratamiento quirúrgico. Se concluye que no existen diferencias sustanciales entre ambos tratamientos, salvo en lo que se refiere a que la cimetidina es significativamente superior cuando el sangramiento digestivo alto es causado por úlcera péptica no originada por estrés(AU)