Valoración del interrogatorio de la alergia a antibióticos en la historia clínica / Assessment of the antibiotic allergy questionnaire in the medical history

Introducción: el interrogatorio clínico es un instrumentoeficaz para evaluar la alergia a los antibióticos. El objetivo denuestro trabajo es valorar su prevalencia y su fiabilidad para ladetección de alergias en las historias clínicas.Métodos: análisis observacional de la presencia del datode alergia a los antibióticos en las historias de un hospital general.Comprobación mediante interrogatorio dirigido de lafiabilidad del dato.Resultados: se evalúan 610 historias. En 98% de los casosconstaba interrogada la alergia a antibióticos. Setenta y un pacientes(12%) tenían registrada alergia a algún antibiótico. Enla valoración por el investigador, sólo un 5% (33 de 610 casos)resultó tener alergia. De detectó un 44% de falsas alergia. Lascausas más frecuentes de confusión fueron lipotimia e intoleranciagástrica.Conclusiones: la presencia del dato de alergia o no a losantibióticos es prácticamente constante en todas las historiasclínicas. La prevalencia de alergia a algún antibiótico medianteinterrogatorio dirigido es del 5%. Es necesario explicar periódicamenteal colectivo sanitario el significado de la alergia a losantibióticos y la importancia del interrogatorio dado que ésteconstituye un instrumento rápido, sencillo y muy eficaz(AU)

Objectives: Antibiotic allergy questionnaire is a usefultool for prescribing antibiotics. The objective of thisstudy is to assess the prevalence and clinical reliabilityof antibiotic allergy in medical records.Patients and method: Observational analysis of clinicalrecords. Assessment of antibiotic allergy by directinterview conducted by the investigator.Results: 610 medical records were evaluated. Antibioticallergy was checked in 98%, mainly in medicalwards. In 12 % of patients, antibiotic allergy was suspected,but after investigator interview only 5% of patientsfulfilled clinical criteria for allergy. 44% of falsesallergies were recorded. The most frequent cause of confusionwas faint and gastric intolerance.Conclussion: The questionnaire about antibioticallergy is present in almost all medical records. Howeverits reliability is low, less than 50%. Prevalence of veritableantibiotic allergy is 5% in this study. Antibioticallergy questionnaire in medical records is a practical tool.However periodical training about antibiotic allergydefinition is necessary for nurses and medical staff(AU)

[Assessment of the antibiotic allergy questionnaire in the medical history]. / Valoración del interrogatorio de la alergia a antibióticos en la historia clínica.

OBJECTIVES: Antibiotic allergy questionnaire is a useful tool for prescribing antibiotics. The objective of this study is to assess the prevalence and clinical reliability of antibiotic allergy in medical records. PATIENTS AND METHOD: Observational analysis of clinical records. Assessment of antibiotic allergy by direct interview conducted by the investigator. RESULTS: 610 medical records were evaluated. Antibiotic allergy was checked in 98%, mainly in medical wards. In 12 % of patients, antibiotic allergy was suspected, but after investigator interview only 5% of patients fulfilled clinical criteria for allergy. 44% of falses allergies were recorded. The most frequent cause of confusion was faint and gastric intolerance. CONCLUSIONS: The questionnaire about antibiotic allergy is present in almost all medical records. However its reliability is low, less than 50%. Prevalence of veritable antibiotic allergy is 5% in this study. Antibiotic allergy questionnaire in medical records is a practical tool. However periodical training about antibiotic allergy definition is necessary for nurses and medical staff.

Corynebacterium macginleyi como agente excepcional de endocarditis infecciosa: a propósito de un caso / Corynebacterium macginleyi as an exceptional cause of endocarditis: a case report

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Corynebacterium macginleyi como agente excepcional de endocarditis infecciosa: a propósito de un caso / Corynebacterium macginleyi como agente excepcional de endocarditis infecciosa: a propósito de un caso

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Miopatía inducida por colquicinacon miotonía asociada / Myopathy by colchicine with myotonia

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Anticardiolipin antibodies and dependence of a serum cofactor. A mechanism of thrombosis.

OBJECTIVE: To evaluate the dependence on the serum cofactor of anticardiolipin antibodies (aCL) in infectious and autoimmune diseases. We also studied their correlation with some clinical manifestations, specially thrombosis. METHODS: aCL were determined with a standard ELISA method, and a modified ELISA in which we substituted bovine serum albumin (BSA), gelatin and skim milk powder for fetal calf serum (FCS). Categorized variables were analyzed by means of the chi 2 test and Fisher's test. Four groups of patients were studied. Group 1. Patients with aCL and autoimmune disease (systemic lupus erythematosus [SLE] and the primary antiphospholipid syndrome [PAPS]). Group 2. Patients with aCL, no symptoms and no underlying infection or autoimmune disease. Group 3. Patients with aCL and infectious diseases (syphilis, leprosy, HIV infection and Q fever). Group 4. Control group. RESULTS: (a) 19 of 20 samples from patients in Group 1 disclosed cofactor dependence in aCL activity. (b) 17 of 19 samples from patients in Group 3 had aCL activity, that was independent of the presence of the cofactor. (c) 3 of 4 patients in Group 2 had cofactor independent aCL and one had cofactor dependent aCL activity. (d) no control group patient had aCL. (e) association of cofactor dependent aCL with the development of clinical manifestations (thrombosis) was statistically significant (p < 0.0001). (g) cofactor dependent aCL and cofactor independent aCL were, respectively, associated with autoimmune and infectious diseases (p < 0.0001). CONCLUSIONS: (a) Dependence or independence of the cofactor helps to differentiate "infectious" aCL from "autoimmune" aCL. (2) aCL related clinical manifestations (thrombosis) depends on the presence of cofactor dependent aCL and not on cofactor independent aCL.

High grade atrioventricular heart block in 2 adults with systemic lupus erythematosus.

We describe 2 patients with systemic lupus erythematosus (SLE) and high grade atrioventricular (AV) block. In one patient anti-Ro antibodies were positive. This antibody has been associated with congenital complete heart block in children of mothers with SLE; however, its role in adult high grade AV block is not clear. We reviewed the 8 published cases of adults with SLE and high grade AV block. The possible mechanisms that could be implicated in the pathology of high grade AV block are discussed.

[Usefulness of cyclosporin in the treatment of pemphigus vulgaris. Apropos of 3 cases]. / Utilidad de la ciclosporina en el tratamiento del pénfigo vulgar. A propósito de 3 casos.

Cyclosporin is a useful drug in several autoimmune diseases. It has been recently evaluated, with varying results, in several dermatoses such as pemphigus vulgaris. Three cases of this condition treated with cyclosporin are reported. The drug permitted to reduce and then to suppress prolonged corticosteroid therapy, and remission was maintained after exacerbation even in monotherapy. Hypertrichosis and gum hypertrophy were the common adverse effects.

[Infectious endocarditis in drug addicts: a study of 71 cases]. / Endocarditis infecciosa en drogadictos: estudio de 71 casos.

Infective endocarditis (IE) is a severe and relatively common condition in parenteral drug abusers (PDA). Seventy-one IE episodes in 59 PDAs admitted to the Hospital General Vall d'Hebron from August 1978 to December 1988 were evaluated. The disease basically involved young males, with a progressively increasing incidence throughout the decade and a higher frequency during August. Fever was a constant symptom, with a duration of less than 10 days before admission in 73% of cases. Staphylococcus aureus was the most common pathogen (85% of episodes). Vegetations were detected by echocardiography in 70% of cases. In 82% of episodes the right side of the heart was involved, particularly the tricuspid valve. The initial chest X-ray film was abnormal in 57.5% of episodes. In 7 patients features of heart failure were present at admission; most had left heart endocarditis. Three patients with left heart endocarditis required surgical therapy. Overall mortality was 13%; it was 6% in patients with only tricuspid involvement and 27% when the left heart was involved.

[Acute interstitial secondary to tricuspid endocarditis caused by Staphylococcus aureus]. / Nefritis intersticial aguda secundaria a endocarditis tricuspidea por Staphylococcus aureus.

The kidney diseases in patients with bacterial endocarditis and intravenous drug addicts (IVDA) tend to be of glomerular origin. Interstitial nephritis has been related to drug toxicity and only occasionally has it been described in other associations. We describe a 27-year-old patient IVDA with tricuspid endocarditis caused by S. Aureus whose first manifestations was acute renal failure. The renal biopsy showed an interstitial nephritis. It was treated with antibiotic and hemodialysis, obtaining the cure and normal levels of plasmatic creatinine.