[Self-perception of disease in patients with chronic diseases]. / Autopercepción de enfermedad en pacientes con enfermedades crónicas.

OBJECTIVE: The aim of this study is to assess the self-perception of disease by patients with chronic diseases and determine factors related to their perception of disease. MATERIAL AND METHODS: Cross-sectional descriptive study performed between September 2014 and April 2015 in nine (6 urban and 3 rural) Health Centres of Navarra, Spain. The participants were recruited by convenience sampling of 196 patients aged over 65 years with at least one chronic disease. The outcome variable was: Perception of disease evaluated through The Brief Illness Perception Questionnaire (9 items. Assessment of the cognitive and emotional representation of the disease. A higher total score indicates a greater threat of disease to the patient). Explanatory variables: Evaluation of the care received through the Patient Assessment of Chronic Illness Care, Katz index, Gijon's socio-family evaluation scale and quality of life using the EQ5D questionnaire. Other variables studied were: gender, age, education, Charlson index, and number of chronic diseases. The association between the total The Brief Illness Perception Questionnaire value and the rest of the variables was calculated. RESULTS: The self-perception of disease is more negative for a larger number of diseases (rho: 0.242; p=.001), greater patient dependence (rho: -0.193; P=.007), and a poorer self-perceived quality of life (EQ VAS rho: -0.484; P<.001. EQ5D5L Index value rho: -0.507; P<.001). CONCLUSIONS: The perception that chronic patients have about their disease worsens as their diseases and their dependence increase, and also worsens their quality of life.

Risk factors for mortality after surgery of osteoporotic hip fracture in patients over 65 years of age. / Factores de riesgo de mortalidad tras intervención quirúrgica de fractura de cadera osteoporótica en pacientes mayores.

OBJECTIVE: To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. MATERIAL AND METHODS: A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. RESULTS: The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. DISCUSSION AND CONCLUSION: Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan.

Multiingreso en el Servicio de Medicina Interna de un hospital terciario / Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital

Antecedentes y objetivos. El paciente multiingresador origina un gran consumo de recursos sanitarios. Hemos estudiado los factores asociados con el ingreso hospitalario múltiple en una cohorte de pacientes asistidos en un Servicio de Medicina Interna. Pacientes y métodos. Se analizaron 613 ingresos hospitalarios consecutivos. Se definió como paciente multiingresador a aquel que al ingresar contabilizaba 3 ingresos o más en los últimos 12 meses. Se analizó la relación de factores demográficos, clínicos y sociales con la característica de ser multiingresador. Además, se analizó el reingreso en los 6 meses siguientes al alta así como el fallecimiento en el ingreso y en los 6 y 12 meses siguientes al alta. Resultados. Los multiingresadores se caracterizaron frente a los no multiingresadores por ser de sexo masculino, ser más jóvenes y presentar mayor comorbilidad, mayor consumo de medicaciones y mayor puntuación en el índice de Katz. La principal causa de ingreso de los multiingresadores fue la «descompensación de una enfermedad crónica» (87,3%). Las enfermedades que se asociaron de forma más destacada con el multiingreso fueron la insuficiencia cardiaca, la diabetes mellitus y la enfermedad pulmonar obstructiva crónica. En los 6 primeros meses tras el alta los multiingresadores presentaron más reingresos. Durante el periodo de estudio, falleció el 40,4% de los pacientes multiingresadores y el 28,8% de los pacientes no multiingresadores. Conclusiones. Los pacientes multiingresadores presentaron mayor complejidad clínica que los no multiingresadores, y el multiingreso se asoció con las enfermedades crónicas, la polifarmacia, el deterioro funcional y tasas elevadas de mortalidad (AU)

Background and objectives. Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. Patients and methods. A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. Results. When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. Conclusions. Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates (AU)

Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital. / Multiingreso en el Servicio de Medicina Interna de un hospital terciario.

BACKGROUND AND OBJECTIVES: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. RESULTS: When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. CONCLUSIONS: Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

[Splenic disorders in internal medicines]. / Lesiones esplénicas en medicina interna.

The spleen is the largest lymphopoietic organ, containing 25% of total lymphoid mass. It participates in cellular and humoral immunity and intervenes in the renovation of red cells and the elimination of bacteria. Splenic functions are reduced when the spleen is absent, which entails, amongst other complications, greater susceptibility to suffering from sepsis due to encapsulated organisms. We present 6 clinical cases admitted to the Internal Medicine serve with splenic pathology and we make a review of the approach to be used. The spectrum of splenic lesions in internal medicine is very wide. On occasions, a splenic pathology can be suspected due to clinical history, physical exploration or because of cytopenias in the analyses. Different complementary tests are available for completing study of these lesions. A splenectomy can be carried out in case of diagnostic doubt, with the most frequent diagnoses being hepatic cirrhosis and lymphoma/leukaemia.

Titanium release in serum of patients with different bone fixation implants and its interaction with serum biomolecules at physiological levels.

Increased concentrations of circulating metal-degradation products derived from the use of Ti orthopaedic implants may have deleterious biological effects over the long term. Therefore, there is an increasing need to establish the basal level of Ti in the serum of the population (exposed and non-exposed) with appropriate highly sensitive techniques and strategies. With this aim, we have developed a quantitative strategy for the determination of total Ti concentration in human serum samples by isotope dilution analysis using a double-focussing inductively coupled plasma mass spectrometer. Minimizing sample handling and therefore contamination issues, we obtained detection limits of about 0.05 µg L(-1) Ti working at medium resolution (m/Δm 4000). Such extremely good sensitivity permitted us to establish the range of Ti concentration in serum of 40 control individuals (mean 0.26 µg L(-1)) and also to compare it with the level in exposed patients with different Ti metal implants. On the other hand, Ti transport "in vivo" studies have been enabled by online coupling of liquid chromatography (anion-exchange) separation and double-focussing inductively coupled plasma mass spectrometry for sensitive detection of Ti. The development of a postcolumn isotope dilution strategy permitted quantitative characterization of the Ti-transporting biomolecules in human serum. The results for unspiked serum revealed that 99.8% of the Ti present in this fluid is bound to the protein transferrin, with column recoveries greater than 95%.

El ictus en el hospital comarcal: por favor, llamen al neurólogo / Strokes in the district hospital: please call the neurologist

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[Acute cerebrovascular disease in the Northern Cordoba Health Area]. / Enfermedad cerebrovascular aguda en el Area Sanitaria Norte de Córdoba.

INTRODUCTION: Its high rates of prevalence, mortality and disability make acute cerebrovascular disease (ACVD) a priority health problem. It is as the second most common cause of admission to internal medicine services. AIMS: To examine inpatient care for ACVD during 2004 in the Valle de los Pedroches health area in the province of Cordoba, as well as survival at six months, so as to be able to carry out the changes needed to improve the attention offered for this condition. PATIENTS AND METHODS: A longitudinal study of the acute phase of the illness and survival at six months was conducted by means of face-to-face interviews. RESULTS: The prevalence of arterial hypertension (75.5%) stands out as a risk factor. The mean age was higher than in other series. There is no characteristic profile of clinical symptoms. The proportion of ischaemic to haemorrhagic strokes falls within the normal range. All 110 patients were submitted to a cranial computerised axial tomography scan in less than three hours. A compromised level of consciousness, senility, haemorrhagic stroke, poorer scoring on the Canadian Neurological Scale and complications all affected mortality rates. The study showed that 20% died while in hospital and 19.1% at six months. At discharge, 30.9% were undergoing rehabilitation. The spouse was the main caregiver in 55.5% of cases. A total of 79% had sequelae at six months. CONCLUSIONS: Instruments that allow fast effective diagnoses and treatments and guarantee proper clinical practice while reducing brain damage and its dependence should be made generally available. Improving primary and secondary prevention is essential in order to halt the progression of ACVD.

Enfermedad cerebrovascular aguda en el Área Sanitaria Norte de Córdoba / Acute cerebrovascular disease in the northern cordoba health area

Introducción. La enfermedad cerebrovascular aguda (ECVA) es un problema de salud prioritario por su elevada prevalencia, mortalidad y discapacidad. Constituye la segunda causa de ingreso en el servicio de medicina interna. Objetivo. Conocer la asistencia hospitalaria en la ECVA durante el año 2004 en el área sanitaria del Valle de los Pedroches en la provincia de Córdoba y la supervivencia a los seis meses para emprender los cambios necesarios que mejoren la atención en este proceso. Pacientes y métodos. Estudio observacional de la fase aguda de la enfermedad y de supervivencia a los seis meses mediante una entrevista personal. Resultados. Destaca la prevalencia de hipertensión arterial (75,5%) como factor de riesgo. La edad media es superior a otras series. No hay un perfil de síntomas clínicos característico. La proporción de ictus isquémico y hemorrágico es la habitual. Los 110 pacientes disponían de tomografía axial computarizada craneal en un tiempo inferior a tres horas. La afectación del nivel de conciencia, la senectud, el ictus hemorrágico, la peor puntuación en la escala canadiense y las complicaciones marcaron la mortalidad. El 20% murió durante el ingreso y el 19,1% a los seis meses. El 30,9% realizaba rehabilitación al alta. En el 55,5% el cuidador principal era el cónyuge. El 79% tenía secuelas a los seis meses. Conclusiones. Deberían generalizarse los instrumentos para el diagnóstico y la terapéutica rápidos y eficaces que garanticen una práctica clínica adecuada y disminuyan el daño cerebral y su dependencia. Es imprescindible mejorar la prevención primaria y secundaria para frenar la progresión de la ECVA

Introduction. Its high rates of prevalence, mortality and disability make acute cerebrovascular disease (ACVD) a priority health problem. It is as the second most common cause of admission to internal medicine services. Aims. To examine inpatient care for ACVD during 2004 in the Valle de los Pedroches health area in the province of Cordoba, as well as survival at six months, so as to be able to carry out the changes needed to improve the attention offered for this condition. Patients and methods. A longitudinal study of the acute phase of the illness and survival at six months was conducted by means of face-toface interviews. Results. The prevalence of arterial hypertension (75.5%) stands out as a risk factor. The mean age was higher than in other series. There is no characteristic profile of clinical symptoms. The proportion of ischaemic to haemorrhagic strokes falls within the normal range. All 110 patients were submitted to a cranial computerised axial tomography scan in less than three hours. A compromised level of consciousness, senility, haemorrhagic stroke, poorer scoring on the Canadian Neurological Scale and complications all affected mortality rates. The study showed that 20% died while in hospital and 19.1% at six months. At discharge, 30.9% were undergoing rehabilitation. The spouse was the main caregiver in 55.5% of cases. A total of 79% had sequelae at six months. Conclusions. Instruments that allow fast effective diagnoses and treatments and guarantee proper clinical practice while reducing brain damage and its dependence should be made generally available. Improving primary and secondary prevention is essential in order to halt the progression of ACVD

Osteolisis maxilar, angiomatosis bacilar en infección por VIH / Maxillar osteolysis, bacilary angiomatosis in HIV infection

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Reliability of biologic indicators in a mail-return sterilization-monitoring service: a review of 3 years.

Most mail-return sterilization-monitoring services use spore strips to test sterilizers in dental clinics, but factors such as delay caused by mailing to the laboratory could cause false negatives. The aims of this study were to determine the influence of poststerilization time and temperature on the biologic indicator recovery system and to evaluate sterilization failure and its possible causes in dental clinics subscribing to a mail-return sterilization-monitoring service. Spore strips used in independent tests revealed the poststerilization time and temperature after a 7-day delay to have no significant influence. Sixty-six dental clinics that received quarterly biologic indicators to evaluate the effectiveness of their sterilizers had sterilization failure rates of 28.7% in 1992, 18.1% in 1993, and 9.1% in 1994, a statistically significant decrease in sterilization failure during the 3-year period. The usual causes of failure were operator error in wrapping of instruments, loading, operating temperature, or exposure time.

[Erythema chronicum migrans (Lyme's disease). Clinico-epidemiologic study of 10 cases]. / Eritema crónico migratorio (enfermedad de Lyme). Estudio clínico epidemiológico de diez casos.

Migratory Chronic Erythema (MCE), which is the distinctive and diagnostic lesion of Lyme's disease, could manifest itself under different clinical manifestations. Following a clinical and a epidemiological point of view 10 cases of MCE, diagnosed during the last three years, have been studied and described. Its wide variability of the clinical manifestations is underlined, with a mean incubation period of 5.6 days between the onset of cutaneous symptoms and the tick bite. The zones mainly affected were lower limbs followed by trunk and neck. Size of lesion varied from 5 to 30 cm, with a mean of 13 cm. In two patients satellite cutaneous lesions were observed and six showed extra-cutaneous signs. Only in four patients antibodies against Borrelia burgdorferi were detected. Regarding epidemiology we did not found differences between the sexes, or by living on an urban or rural area. The tick bite was referred in half of the cases, 30% of the patients have a job related with wood, forest, farming or cattle. The season in which MCE was most frequent was spring-beginning of summer and end of summer-beginning of autumn. All patients responded to the therapy with tetracyclines and/or macrolides.

Interaction of calmodulin with lactoferrin.

Calmodulin, as a major intracellular calcium-binding protein, regulates many Ca(2+)-dependent enzymes and plays an important role in a wide spectrum of cellular functions of the eukaryotes. Interaction between calmodulin and human lactoferrin, a 78 kDa protein with antibacterial properties, was found in the presence of Ca2+ using (i) a method for the detection of calmodulin binding proteins with biotinylated calmodulin, (ii) affinity chromatography on an agarose-calmodulin column with subsequent detection by an enzyme-linked immunosorbent assay (ELISA). The binding of calmodulin to lactoferrin blocked the ability of lactoferrin to agglutinate Micrococcus lysodeikticus.