Extended anticoagulation in venous thromboembolism disease. In favour. / Anticoagulación extendida en la enfermedad tromboembólica venosa. A favor.

Venous thromboembolism disease can be considered a chronic disease because, after the first episode, there is a life-long risk of recurrence. Recurrence is a severe complication. Anticoagulation is effective while it is maintained, but when it is discontinued, the risk of new thrombotic events persists indefinitely. Clinical practice guidelines offer specific recommendations on the treatment duration for patients with provoked or recurrent disease but are not specific for those with a first unprovoked episode. The decision should be made after a careful individual assessment of the risk-benefit of anticoagulation. This article reviews the evidence in favour of extending the anticoagulation and the current therapeutic options.

[Climate change: new diseases for a new climate?]. / Cambio climático: euronuevas enfermedades para un nuevo clima?

Since the beginning of the 20th century, there has been a progressive increase in the Earth's temperature. This warming of the Earth's surface is largely due to the so-called green house effect that can alter the natural behavior of some natural phenomena such as El Niño. Several articles on climate change have been published recently. Some authors have raised the question of whether these changes could affect human health or even lead to the reappearance of some eradicated diseases. This report focuses on the changes seen in health up to date and their probable causes. Some changes in energy emission levels have been proposed in order to restrain this trend.

Cambio climático: ¿nuevas enfermedades para un nuevo clima? / Climate change: new diseases for a new climate?

Desde comienzos del siglo xx la temperatura terrestre ha ido aumentando de manera progresiva. Este calentamiento de la superficie terrestre, debido en gran parte al llamado efecto invernadero, podría alterar el curso natural de ciertos fenómenos naturales como el de El Niño. Recientemente se han publicado varios artículos acerca del cambio climático. Algunos autores han planteado la hipótesis de si ello podría tener algún efecto sobre la salud humana o facilitaría incluso la reaparición de ciertas enfermedades erradicadas actualmente. Este artículo se centra en los cambios evidenciados en la salud hasta la fecha y sus posibles causas. Se han propuesto varios cambios en la emisión energética para frenar esta tendencia (AU)

Since the beginning of the 20th century, there has been a progressive increase in the Earth's temperature. This warming of the Earth's surface is largely due to the so-called green house effect that can alter the natural behavior of some natural phenomena such as El Niño. Several articles on climate change have been published recently. Some authors have raised the question of whether these changes could affect human health or even lead to the reappearance of some eradicated diseases. This report focuses on the changes seen in health up to date and their probable causes. Some changes in energy emission levels have been proposed in order to restrain this trend (AU)

[Prescription errors in patients admitted to an internal medicine department from the emergency room]. / Errores de prescripción en pacientes que ingresan en un servicio de medicina interna procedentes de urgencias.

OBJECTIVE: To identify and quantify emergency room prescription errors upon patient admission in an internal medicine unit, assess their severity and causes, and evaluate their potential clinical impact. METHOD: Discrepancies found between emergency room and internal medicine unit prescriptions were analyzed by 4th-year resident pharmacists. Prescription errors were collected and classified according to their severity and potential morbidity, and a medical analysis of service value was performed according to Overhage's method. Furthermore, pharmacist actions regarding therapeutic regimen optimization are described. RESULTS: Of 177 patients, 50 had prescription errors, for a total of 141 errors. Seven percent of prescriptions had an error. Mean errors per patient amounted to 0.8 (SD 1.51). Most commonly involved medications included anti-asthmatic and anti-infectious agents, and fluid therapy agents. On severity assessment 12.8% were considered severe, and 57.4% were considered significant. The main cause was omission of a needed therapy. Potential pharmacotherapeutic morbidity is related to adverse effects and cardiovascular disease. Medical assessment considered 12% very significant, and 52% significant. Pharmacist actions were directed towards effectiveness improvement in 57% of cases, and safety in 43.2% of cases. CONCLUSIONS: Emergency departments, as main entry points for patient admission to hospital, should be considered a priority in prescription quality improvement programs.

Errores de prescripción en pacientes que ingresan en un servicio de medicina interna procedentes de urgencias / Prescription errors in patients admitted to an internal medicine department from the emergency room

Objetivo: En este estudio se detectan y cuantifican los errores de prescripción del servicio de urgencias al ingresar los pacientes en una unidad de medicina interna, se evalúa la gravedad y las causas, así como el potencial impacto clínico de los mismos. Método: Las discrepancias encontradas en las prescripciones del servicio de urgencias y de medicina interna fueron analizadas por farmacéuticos residentes de cuarto año. Se extrajeron los errores de prescripción y se clasificaron de acuerdo a la gravedad y potencial morbilidad, se hizo un análisis médico del valor del servicio, siguiendo el método de Overhage. Se describe, además, la actuación del farmacéutico en la optimización del régimen terapéutico. Resultados: De 177 pacientes, 50 presentaron errores de prescripción, obteniéndose un total de 141 errores. El 7% de las prescripciones presentaban un error. La media de errores por paciente era de 0,8 (DE 1,51). Los medicamentos más implicados fueron antiasmáticos, antiinfecciosos y fluidoterapia. En la valoración de la gravedad fueron considerados serios el 12,8% y significativos el 57,4%. La causa principal fue la omisión de tratamiento necesario. La morbilidad farmacoterapéutica potencial se relaciona con efectos adversos y enfermedades del sistema cardiocirculatorio. La evaluación médica consideró muy significativos el 12% y significativos el 52%. La actuación farmacéutica se dirigió a la mejora de la efectividad en un 57% de los casos y a la seguridad en un 43,2%. Conclusiones: Los datos obtenidos concuerdan con otros autores en la prevalencia de errores de prescripción en el ámbito del ingreso hospitalario. Sin embargo, se pone en evidencia la dificultad de valorar la morbilidad farmacoterapéutica potencial según los diferentes resultados que se han obtenido en los estudios con los cuales se ha comparado. Pero según los resultados, los servicios de urgencias, cuando son puerta principal de entrada del paciente en el hospital, han de ser considerados como prioritarios en los programas de mejora de la calidad de la prescripción

Objective: To identify and quantify emergency room prescription errors upon patient admission in an internal medicine unit, assess their severity and causes, and evaluate their potential clinical impact. Method: Discrepancies found between emergency room and internal medicine unit prescriptions were analyzed by 4th-year resident pharmacists. Prescription errors were collected and classified according to their severity and potential morbidity, and a medical analysis of service value was performed according to Overhage’s method. Furthermore, pharmacist actions regarding therapeutic regimen optimization are described. Results: Of 177 patients, 50 had prescription errors, for atotal of 141 errors. Seven percent of prescriptions had an error. Mean errors per patient amounted to 0.8 (SD 1.51). Most commonly involved medications included anti-asthmatic and anti-infectious agents, and fluid therapy agents. On severity assessment 12.8% were considered severe, and 57.4% were considered significant.The main cause was omission of a needed therapy. Potential pharmacotherapeutic morbidity is related to adverse effects and cardiovascular disease. Medical assessment considered 12% very significant, and 52% significant. Pharmacist actions were directed towards effectiveness improvement in 57% of cases, and safety in 43.2% of cases. Conclusions: Emergency departments, as main entry points for patient admission to hospital, should be considered a priority in prescription quality improvement programs

[Histiocytic necrotizing lymphadenitis: Kikuchi-Fujimoto disease. Apropos of 6 cases]. / Linfadenitis necrotizante histiocitaria: enfermedad de Kikuchi-Fujimoto. A propósito de 6 casos.

Necrotizing Histiocytic Lymphadenitis or Kikuchi-Fujimoto disease is a benign process of lymphatic system that consists of lymphadenopathy which may be accompanied by fever, rash and some haematological alterations as anaemia. It affects usually young people, mostly women. Although it is more frequent in Oriental countries, there have been some notices about this disease in Europe recently. We present six patients that have been diagnosed in our Hospital between 1986 and 1996. All presented as cervical masses and fever. The diagnostic procedure was the lymph node biopsy, which showed the typical pathology of this disease: some foci of necrosis which contained plasmocytoides cells and atypical lymphocytes. It is also suggestive of this entity the absence of polymorphonuclear cells. Then, the diagnosis of the Necrotizing Histiocytic Lymphadenitis is made by the histology. The treatment is symptomatic. In all cases the evolution is the whole remission of symptoms. In our patients the illness was self-limited and none presented any other symptom. Our proposal with this article is to remind the clinicians of this entity when people ask for cervical masses and fever.

infadenitis necrotizante histiocitaria: enfermedad de Kikuchi-Fujimoto.A propósito de 6 casos# / istiocytic necrotizing lymphadenitis: kikuchi-fujimoto disease: report of six cases#

La Linfadenitis Necrotizante Histiocitaria o Enfermedad de Kikuchi-Fujimoto es un proceso benigno del sistema linfático caracterizado por linfadenopatías y que puede acompañarse de síndrome febril prolongado, rash cutáneo, alteraciones hematológicas leves como anemia o trombopenia. Suele aparecer en personas de edad joven, generalmente mujeres. Aunque inicialmente se había descrito en países orientales, en los últimos años se han publicado varios casos en Europa. En este trabajo incluimos los datos de seis pacientes que fueron estudiados en nuestro Hospital entre los años 1986 y 1996. Los seis pacientes estaban siendo estudiados por la presencia de fiebre y tumefacciones cervicales. La prueba diagnóstica en todos ellos fue la realización de una biopsia de una de las adenopatías. Ésta mostraba en todos los casos la histología característica de la enfermedad, que consiste en la observación de focos de necrosis dispersos por el ganglio, además de la presencia de histiocitos atípicos y células plasmocitoides. También es un dato característico en esta enfermedad la ausencia de polimorfonucleares neutrófilos. El diagnóstico de la Linfadenitis Necrotizante Histiocitaria es, por tanto, anatomo-patológico. En cuanto a la evolución y pronóstico, es un proceso autolimitado, benigno, que hasta la fecha no se ha relacionado con la aparición posterior de procesos linfoproliferativos, infecciosos u otros. El tratamiento de esta entidad, cuando es necesario, es puramente sintomático. En nuestros pacientes la evolución fue a la remisión completa de los síntomas, sin que ninguno de los pacientes presentaran recaídas posteriores. Con este trabajo pretendemos llamar la atención sobre esta entidad benigna en todos aquellos pacientes que se presentan con adenopatías y fiebre (AU)

[Leprosy: identification of an isolated case]. / Lepra: detección de un caso aislado.

Leprosy is an infrequent disease in Spain. 4,714 cases of leprosy was registered in the last national census (1979). The disease is still common in certain regions, such as Levant, Andalusia, Extremadura, Canary Island and Galicia. Lepromatous type is more frequent, a typical hallmark of endemies with low activity or characterized by regression. We report a patient affected of borderline lepromatous leprosy with the following characteristics: 1) the only known case in his locality, 2) lack of reaction after the treatment, and 3) due to its clinic, histological, and bacteriological characteristics was quite difficult to determine the leprosy's type. Even though the leprosy is an infrequent disease, it can be seen in everyday's practice, so that the internist and specialist. Have to know the disease in order to make an early diagnosis and to treat the patient effectively.

[Transient elevation in immunity in a senile female patient]. / Exaltación transitoria de la inmunidad en una paciente senil.

A case of an 85 year old female patient who during an infectious episode developed multiple autoimmune markers, autoantibodies, hypergammaglobulinemia, bicytopenia, hemolytic anemia, and cryoglobulinemia is described. All the anomalies disappeared during the following four weeks and during this period the patient presented no clinical manifestations. The hypothesis is that the infectious stimulus provoked a markedly exaggerated response. We highlight the rareness of this out of proportion transitory and silent immune response, emphasizing the greater cell sensibility to different stimuli in older patients.