Mujer de 84 años con una úlcera necrótica en el miembro inferior izquierdo / No disponible

No disponible

Celulitis de codo / Cellulitis of the elbow

No disponible

[Are short stay medical units an appropriate place to manage community-acquired pneumonia?]. / ¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad?

INTRODUCTION: Evaluate patients with community acquired pneumonia (CAP) admitted to our Short Stay Medical Unit (SSMU) in order to establish, using Fines s criteria, whether reducing the length of stay of maximum risk groups (IV and V) is associated with reduction of quality with either an increase of mortality or readmissions. A further objective was to pinpoint the variables associated with a prolongation of hospital stay. PATIENTS AND METHODS: All CAP patients admitted to our unit over a eighteen-month period were included in the study. We conducted an univariate analysis and a step wise multivariate analysis of all the variables in the univariate analysis showing a significant statistical relation. RESULTS: 182 patients with a mean age of 73 years were studied. The length of hospital stay was 4.3 days. Stratified by Fine's criteria, 91.2% were included in the groups of maximum risk: 12.1% in group III, 60.4% IV and 18.7% in V. The medium length of stay for each category was 4.3, 4.1 y 5.3 days respectively. The mortality rate was 2.7% and only 5 patients required readmission within one month alter the discharge. Of the variables analyzed only Fine's group V, chronic liver disease and/or renal insufficiency as comorbidities, a pulse rate over 125 per minute and blood glucose level > 250 mg/l showed a significant relation with more than five days hospitalization, and out of them, only the three latter stayed in the multivariate analysis. CONCLUSIONS: All CAP patients, including those in Fine's groups IV and V, can be treated safely and efficiently in a SSMU, providing there is an outpatient clinic for immediate consultation available.

Morbilidad hospitalaria en pacientes con infección por VIH / Hospital morbidity in HIV infected patients

Fundamento y objetivo: Con el aumento de la esperanza de vida en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) tras el tratamiento antirretroviral de gran actividad (TARGA), las causas de hospitalización han cambiado. Predominan ahora comorbilidades como la hepatopatía crónica, la patología cardiovascular o los efectos secundarios de los tratamientos. Nuestro objetivo es determinar las características clinicoepidemiológicas actuales de estos pacientes. Material y métodos: Estudio descriptivo y retrospectivo. Revisamos las historias clínicas de los ingresos de pacientes con infección por el VIH hospitalizados en los servicios médicos de nuestro hospital en el transcurso de un año. Resultados: Hubo 125 ingresos de 82 pacientes, un 77% varones y un 71% con infección por el virus de la hepatitis C (VHC). La edad media fue de 42 años. En el 64% la vía de transmisión fue la drogadicción parenteral. Un 36% recibían TARGA y un 51% reunían criterios sida. Los motivos de ingreso más frecuentes fueron la patologia respiratoria (32%) y las enfermedades definitorias de sida (EDS) con un 22%, de las que la tuberculosis (TBC) fue la más frecuente. Un 10% fueron ingresados en la Unidad de Cuidados Intensivos (UCI). La mortalidad fue del 11% pacientes/año. Conclusiones: La mayoría de los pacientes fueron varones, con coinfección por el VHC y usuarios de drogas vía parenteral, siendo las causas de ingreso más frecuentes las patologías respiratorias y las enfermedades oportunistas. La TBC permanece siendo la EDS más frecuente

Background and objetive: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver patology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. Material and methods: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. Results: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract patology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. Conclusions: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness

¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad? / Are short stay medical units an appropiate place to manage community acquired pneumonia?

Introducción: Evaluar los pacientes ingresados por neumonía adquirida en la comunidad (NAC) en una unidad de corta estancia médica (UCEM) para determinar, mediante los criterios de Fine para, si la reducción de la estancia en los grupos de máximo riesgo (grupos IV y V) lleva asociada una disminución de la calidad asistencial en forma de mortalidad y reingresos. Pacientes y métodos: Se incluyeron todos los pacientes con NAC ingresados en la UCEM en un periodo de 18 meses. Se realizó un estudio univariante contrastando cada variable con la variable resultado (estancia > o 250 mg/l, se relacionaron con una estancia mayor de 5 días y de ellas únicamente las 3 últimas permanecieron en el modelo final en el análisis multivariante. Conclusiones: La NAC se puede tratar de forma eficiente en una UCEM incluso en pacientes incluidos en los grupos IV y V de Fine, apoyados en una consulta externa ágil y precoz que permita una revisión temprana

Introduction: Evaluate patients with community acquired pneumonia (CAP) admitted to our Short Stay Medical Unit (SSMU) in order to establish, using Fines’s criteria, whether reducing the length of stay of maximum risk groups (IV and V) is associated with reduction of quality with either an increase of mortality or readmissions. A further objective was to pinpoint the variables associated with a prolongation of hospital stay. Patients and methods: All CAP patients admitted to our unit over a eighteen-month period were included in the study. We conducted an univariate analysis and a step wise multivariate analysis of all the variables in the univariate analysis showing a significant statistical relation. Results: 182 patients with a mean age of 73 years were studied. The length of hospital stay was 4.3 days. Stratified by Fines’s criteria, 91.2% were included in the groups of maximum risk: 12.1% in group III, 60.4% IV and 18.7% in V. The medium length of stay for each category was 4.3, 4.1 y 5.3 days respectively. The mortality rate was 2.7% and only 5 patients required readmission within one month alter the discharge. Of the variables analyzed only Fine’s group V, chronic liver disease and/or renal insufficiency as comorbidities, a pulse rate over 125 per minute and blood glucose level > 250 mg/l showed a significant relation with more than five days hospitalization, and out of them, only the three latter stayed in the multivariate analysis. Conclusions: All CAP patients, including those in Fine’s groups IV and V, can be treated safely and efficiently in a SSMU, providing there is an outpatient clinic for inmmediate consultation available

Síndrome de hipersensibilidad a fenitoína / Hipersensitivity syndrome to phenitoin

No disponible

No disponible

[Hospital morbidity in HIV infected patients]. / Morbilidad hospitalaria en pacientes con infección por VIH.

BACKGROUND AND OBJECTIVE: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver pathology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. MATERIAL AND METHODS: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. RESULTS: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract pathology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. CONCLUSIONS: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness.

Dolor torácico y colitis ulcerosa / Toracic pain and ulcerous colitis

No disponible

[Distal musculo-skeletal manifestations in rheumatic polymyalgia]. / Manifestaciones musculoesqueléticas distales en la polimialgia reumática.

The frequency and characteristics of distal musculo-skeletal manifestations (DMM) are reported in a series of 136 patients with the diagnosis of rheumatic polymyalgia (RPM). Thirty-eight patients (28%) had DMM concomitantly with the diagnosis of RPM or during its course. Peripheral arthritis were most common, and 40 episodes were identified in 31 patients. Eight patients had the typical manifestations of the pitting edema. Tenosynovitis was observed in four patients and the carpal tunnel syndrome in three. Five patients had 2 DMM manifestations associated. In 80% of cases the detection of DMM occurred at diagnosis, and were associated with the characteristic proximal symptoms in RPM. The response to corticosteroid therapy was favorable in all cases. The eight patients with pitting edema had an ESR lower at diagnosis and a shorter total length of treatment of RPM.