Fiebre en Urgencias: detección de patología grave / Fever in Emergency Department: screening for severe disease

Fundamento y objetivo. Conocer las variables que se asocian a la patología grave en los pacientes adultos con fiebre en Urgencias. Material y métodos. Estudio prospectivo observacional. Se recogieron datos de todos los pacientes adultos con fiebre (temperatura axilar superior a 37,7 °C) atendidos en el área médica del Servicio de Urgencias de nuestro hospital entre el 28 de enero al 30 de abril de 2006. Las variables recogidas se incluyeron en un análisis de regresión logística, siendo la variable dependiente principal «enfermedad grave». En función del riesgo correspondiente se asignó una puntuación a cada variable que permitiera diseñar una escala de riesgo de enfermedad grave. Resultados. Se atendieron 11.271 pacientes, de los cuales 786 tenían fiebre (7,0%). La edad media fue 39 años (37-40), 57% varones, 13% inmigrantes. Ingresaron un 31% y presentaron patología grave un 27%. En función de los datos clínicos se sospechó focalidad respiratoria alta en 309 (39%) y baja en 130 (17%), foco abdominal en 117 (15%), foco urinario en 40 (5%) y sin foco aparente en 145 (18%). Se asociaron a patología grave comorbilidad (odds ratio [OR] 3,6; intervalo de confianza [IC]95% 1,8-7,2) (4 puntos), proteína C reactiva (PCR) superior a 10 mg/dl (OR 1,8; IC95% 1,1-3,7) (2 puntos), edad (OR 1,02; IC95% 1,01-1,04) (edad superior a 60 años 3 puntos) y fue factor protector la fiebre de probable origen respiratorio alto (OR 0,4; IC95% 0,2-0,9) (fiebre de otro foco 3 puntos). Tenían patología grave el 3% de los pacientes con menos de 3 puntos y el 72% de los que tenían más de 7 puntos. Conclusiones. En los adultos con fiebre en Urgencias la presencia de comorbilidad, un nivel de PCR superior a 10mg/dl, la focalidad diferente a una infección de las vías respiratorias altas y la edad se asociaron a una patología grave (AU)

Background. To identify variables associated to severe disease in adult patients with fever in the Emergency Department. Material and methods. Observational, perspective study. Data from all the adult patients with fever (axillary temperature 37.8 °C or higher) seen in the medical area of the Emergency Department was collected from January 28th to April 30th of 2006 and included in a logistic regression analysis, the dependent variable being «severe disease». Based on the corresponding risk, a score was assigned to each variable to design a risk of severe disease model. Results. A total of 11271 patients were seen, 786 (7.0%) of whom had fever. Median age was 39 years (37-40), 57% male. Of these, 31% were admitted and 27% had severe disease. Based on the symptoms and signs, upper airways infection was suspected in 309 (39%) and lower airways infection in 130 (17%), abdominal infection in 117 (15%), urinary tract infection in 40 (5%) and no source of infection in 145 (18%). Comorbidity (OR 3.6, 95% CI -1.8-7.2) (4 points), C-reactive protein higher than 10 mg/dl (OR 1.8, 95% CI 1.1-3.7) (2 points) and age (OR 1.02, 95% CI 1.01-1.04) (age older than 60 years 3 points) were associated with severe disease. Fever having a probable upper respiratory origin was a protector factor (OR 0.4, 95% CI 0.2-0.9) (fever from other foci 3 points). Three percent of the patients with less than 3 points had severe disease versus 72% with more than 7 points. Conclusions. Comorbidity, C-reactive protein higher than 10 mg/dl, age and suspicion of source of infection different of upper airways infection were associated to severe disease in adults with fever in the Emergency Department (AU)

[Association of lung adenocarcinoma and human immunodeficiency virus infection]. / Asociación de adenocarcinoma pulmonar e infección por el virus de la inmunodeficiencia humana.

In the past decade, few studies have reported the occurrence of lung cancer in HIV-infected patients. The true frequency of this association is known. The major features of these patients include: male gender, young age, a history of intravenous drug abuse, preponderance of adenocarcinoma cell type and advanced clinical stage at diagnosis. We describe a case of a lung cancer in a man with evidence of advanced HIV-infection and a history of intravenous drug abuse. Subsequently, we review the data reported in the literature about this association. Our patient provides further evidence that lung cancer should be included in the differential diagnosis of intrathoracic diseases in HIV-infected patients.