[Risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge]. / Riesgo de enfermedad tromboembólica y estudio de utilización de tromboprofilaxis en pacientes médicos hospitalizados y al alta hospitalaria.

INTRODUCTION: The aim of this study is to establish the risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge, and their concordance with protocols used in our hospital. MATERIAL AND METHODS: We performed a cross-sectional with prospective follow-up until hospital discharge. It included all medical patients in Internal Medicine, Pneumology and Oncology Departments. The patient's thromboembolic risk and type of thromboembolism prophylaxis indication during hospitalization and after discharge were determined. RESULTS: A total of 116 patients (52 in Internal Medicine Department, 35 in Pneumology Department and 29 in Oncology Department), with a mean age of 67 +/- 17 years (35 females; 81 males) were included. During hospitalization, 62.9% of the patients had a high risk of thromboembolic events, 3.4% a moderate risk, 23.3% low risk, and 10.3% had no risk. After discharge, these proportions were 35.6%, 3.8%, 24% and 34.6%, respectively. A total of 49.1% of the patients had an adequate indication of venous thromboembolism prophylaxis during the hospitalization and after discharge.

Riesgo de enfermedad tromboembólica y estudio de utilización de tromboprofilaxis en pacientes médicos hospitalizados y al alta hospitalaria / Risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge

Introducción. El objetivo de este estudio es conocer el riesgo de enfermedad tromboembólica venosa (ETV) en pacientes médicos durante su ingreso y al alta hospitalaria, y estudiar los hábitos de prescripción de tromboprofilaxis y su adecuación a los protocolos utilizados en nuestro medio. Material y método. Para ello se realizó un estudio transversal con seguimiento prospectivo hasta el alta hospitalaria. Se incluyeron pacientes médicos de los Servicios de Medicina Interna, Neumología y Oncología, en los que se determinó el grado de riesgo de ETV y el tipo de indicación de tromboprofilaxis durante el ingreso y al alta hospitalaria. Resultados. Se incluyeron 116 pacientes (52 en medicina interna, 35 en neumología y 29 en oncología), con una media de edad de 67 ± 17 años (35 mujeres; 81 hombres). En el ingreso el 62,9% tenían alto riesgo de ETV, el 3,4% moderado, el 23,3% bajo y el 10,3% no tenían riesgo. Al alta hospitalaria estos porcentajes fueron de 35,6; 3,8; 24 y 34,6%, respectivamente. La proporción de pacientes con prescripción adecuada a la indicación fue del 49,1%, tanto durante el ingreso como al alta hospitalaria (AU)

Introduction. The aim of this study is to establish the risk of thromboembolic events and evaluation of the use of venous thromboembolism prophylaxis in hospitalized medical patients and after discharge, and their concordance with protocols used in our hospital. Material and methods. We performed a cross-sectional with prospective follow-up until hospital discharge. It included all medical patients in Internal Medicine, Pneumology and Oncology Departments. The patient's thromboembolic risk and type of thromboembolism prophylaxis indication during hospitalization and after discharge were determined. Results. A total of 116 patients (52 in Internal Medicine Department, 35 in Pneumology Department and 29 in Oncology Department), with a mean age of 67 ± 17 years (35 females; 81 males) were included. During hospitalization, 62.9% of the patients had a high risk of thromboembolic events, 3.4% a moderate risk, 23.3% low risk, and 10.3% had no risk. After discharge, these proportions were 35.6%, 3.8%, 24% and 34.6%, respectively. A total of 49.1% of the patients had an adequate indication of venous thromboembolism prophylaxis during the hospitalization and after discharge (AU)

[Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases]. / Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos.

INTRODUCTION: The clinical-epidemiological characteristics of patients who were diagnosed of spontaneous infectious spondylodiscitis (SIS) in our Internal Medicine Department are analyzed and the related factors associated with the increase of the incidence are evaluated. PATIENTS AND METHODS: A cross-sectional, retrospective study of patients diagnosed of SIS from 1996 to 2005 was conducted. The study was divided in two periods: A (1996-2000) and B (2001-2005) and two main etiologic groups (pyogenic SIS and mycobacterial SIS) were compared. RESULTS: A total of 41 patients were diagnosed of SIS: 13 (31.7%) in period A and 28 (68.3%) in period B. Mean age was 58.5 +/- 17.6 years (range: 29-89). There were 73.2% men and all women presented in period B (0 vs 11, p = 0.008). Backgrounds were: 28 (68.3%) predisposing factors for SIS, 22 (53.6%), previous infections and 23 (56.1%) spinal diseases. There were not changes in the backgrounds during the study. The etiology of SIS was: 26 (63.4%) pyogenic, 12 (29.3%) mycobacterial and 3 (7.3%) brucellar. Patients with pyogenic SIS were older (63.6 +/- 3.2 vs 51.2 +/- 5.1 years, p = 0.035) and had less from onset of symptoms to diagnosis (62 +/- 12 vs 291 +/- 66 days, p = 0.0001) than patients with mycobacterial SIS. Total incidence of SIS and incidence of pyogenic SIS increased significantly during the study: (1.7/1000 admissions/year, p = 0.0057) and (1/1000 admissions/year, p = 0.0476). In the multivariate analysis, time from onset of symptoms to diagnosis was the only variable independently associated with the pyogenic etiological group (OR: 0.985, 95% CI: 0.975, 0.996, p = 0.005). CONCLUSIONS: In our study, the increasing incidence of SIS was related to an increase in pyogenic SIS incidence. Although older age and some backgrounds could be orientative of SIS etiology, these factors did not increase during the study.

Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos / Spontaneous Infectious Spondylodiscitis in an Internal Medicine Department: epidemiological and clinical study in 41 cases

Introducción. Se analizan las características epidemiológicas y clínicas de los pacientes diagnosticados de espondilodiscitis infecciosa espontánea (EIE) en nuestro Servicio de Medicina Interna, y valoramos los posibles factores relacionados con el aumento de su incidencia. Pacientes y métodos. Estudio transversal, retrospectivo de los pacientes diagnosticados de EIE desde 1996 hasta 2005. Se ha dividido el tiempo de estudio en dos períodos (A: 1996-2000 y B: 2001-2005) y se compararon los principales grupos etiológicos (EIE piógenas y EIE micobacterianas). Resultados. Se diagnosticaron 41 casos de EIE: 13 (31,7%) en el período A y 28 (68,3%) en el período B. La edad media era 58,5 ± 17,6 años (rango: 29-89). Un 73,2% eran varones; todas las mujeres se presentaron en el período B (0 frente a 11, p = 0,008). Los antecedentes fueron: 28 (68,3%) factores predisponentes de EIE, 22 (53,6%) infecciones previas y 23 (56,1%) patologías de columna. No se observaron modificaciones en los antecedentes a lo largo del estudio. La etiología de la EIE fue: piógena en 26 casos (63,4%), micobacteriana en 12 (29,3%) y brucelar en 3 (7,3%). Los pacientes con EIE piógenas tenían más edad (63,6 ± 3,2 frente a 51,2 ± 5,1 años, p = 0,035) y un menor tiempo de demora desde el inicio de los síntomas hasta el diagnóstico (62 ± 12 frente a 291 ± 66 días, p = 0,0001) que los pacientes con EIE micobacteriana. Se observó un aumento significativo de la incidencia total de EIE (1,7 casos por cada 1.000 ingresos al año, p = 0,0057) y de la incidencia de EIE piógenas (uno de cada 1.000 ingresos al año, p = 0,0476). En el estudio multivariante, el tiempo desde el inicio de los síntomas hasta el diagnóstico fue la única variable independientemente asociada al grupo etiológico piógeno (OR: 0,985, IC95%: 0,975; 0,996, p = 0,005). Conclusiones. El aumento significativo en la incidencia de EIE observada en nuestro estudio ha sido a expensas de un aumento significativo en la incidencia del grupo etiológico piógeno. Aunque la edad avanzada y algunos antecedentes puedan ser orientativos de la etiología de la EIE, este tipo de factores no se incrementaron durante el estudio (AU)

Introduction. The clinical-epidemiological characteristics of patients who were diagnosed of spontaneous infectious spondylodiscitis (SIS) in our Internal Medicine Department are analyzed and the related factors associated with the increase of the incidence are evaluated. Patients and methods. A cross-sectional, retrospective study of patients diagnosed of SIS from 1996 to 2005 was conducted. The study was divided in two periods: A (1996-2000) and B (2001-2005) and two main etiologic groups (pyogenic SIS and mycobacterial SIS) were compared. Results. A total of 41 patients were diagnosed of SIS: 13 (31.7%) in period A and 28 (68.3%) in period B. Mean age was 58.5 ± 17.6 years (range: 29-89). There were 73.2% men and all women presented in period B (0 vs 11, p = 0.008). Backgrounds were: 28 (68.3%) predisposing factors for SIS, 22 (53.6%), previous infections and 23 (56.1%) spinal diseases. There were not changes in the backgrounds during the study. The etiology of SIS was: 26 (63.4%) pyogenic, 12 (29.3%) mycobacterial and 3 (7.3%) brucellar. Patients with pyogenic SIS were older (63.6 ± 3.2 vs 51.2 ± 5.1 years, p = 0.035) and had less from onset of symptoms to diagnosis (62 ± 12 vs 291 ± 66 days, p = 0.0001) than patients with mycobacterial SIS. Total incidence of SIS and incidence of pyogenic SIS increased significantly during the study: (1.7/1000 admissions/year, p = 0.0057) and (1/1000 admissions/year, p = 0.0476). In the multivariate analysis, time from onset of symptoms to diagnosis was the only variable independently associated with the pyogenic etiological group (OR: 0.985, 95% CI: 0.975, 0.996, p = 0.005). Conclusions. In our study, the increasing incidence of SIS was related to an increase in pyogenic SIS incidence. Although older age and some backgrounds could be orientative of SIS etiology, these factors did not increase during the study (AU)