Rigidez de descerebración transitoria en el contexto de hipoxemia y administración de propofol, midazolamflumacenilo y remifentanilo-naloxona / No disponible

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Comorbilidad, pluripatología, consumo de recursos y pronóstico de pacientes ingresados en una unidad de Medicina Interna / Comorbidity, pluripathology, resource use and prognosis of patients hospitalized in Internal Medicine Areas

Objetivo: Comparar la definición de paciente con pluripatología (PP) del Servicio de Salud de Andalucía con el índice de comorbilidad de Charlson (IC) respecto al consumo de recursos y pronóstico de enfermos hospitalizados. Pacientes y métodos: Estudio prospectivo observacional de 207 pacientes ingresados de forma consecutiva en una unidad de medicina interna en los que se determinó la presencia de PP, una variante de PP obtenida de aplicar al menos tres categorías clínicas en lugar de dos (PP3), el IC y su valor ajustado con la edad (ICE), y la relación de estas variables con el consumo de recursos (atenciones urgentes, consultas programadas de especialidades y episodios de hospitalización en los doce meses previos, duración de la estancia, procedimientos propios, procedimientos deotras especialidades e interconsultas) y pronóstico (mortalidad intrahospitalaria, deterioro funcional significativo y reingreso precoz). Resultados: La frecuencia de PP fue de 40,6% y la de PP3 de 16,9%. La mediana de la puntuación del IC fue de 2 (0-7) y la del ICE de 4 (0-11). Se detectaron las siguientes relaciones independientes: IC de 3 o mayor con reingreso precoz y duración de la estancia; ICE de 5 o mayor con la mortalidad; PP3 con la mortalidad, reingreso precoz y con urgencias, ingresos y consultas en el último año; categorías B y F de PP con las hospitalizaciones en el último año; categoría D de PP con las consultas en el último año; y la asociación de categorías A, B y C con la mortalidad y hospitalizaciones en el último año. PP no se relacionó de forma independiente con ninguna variable. Conclusión: El IC y la definición de PP no identifican la misma población de pacientes hospitalizados. Modificaciones de la definición de PP, como PP3, o el análisis de las distintas categorías clínicas de PP y sus asociaciones, podrían mejorar la utilidad de este concepto

Objective: To compare the concept of patient with pluripathology (PP) with the index of comorbidity of Charlson (IC) respect to there sources use and prognosis of hospitalized patients. Patients and methods: An observational prospective study of 207 consecutively hospitalized patients in an internal medicine unit was conducted. The PP, a variant of PP with three or more criteria (PP3), ICand IC fit to the age (ICE) were determined, and their relation with the consumption of resources (emergency attentions, programmed consultations of specialties and episodes of hospitalization in the last year, length of stay, own procedures, other specialty procedures and consulting) and prognosis (hospital mortality, significant functional deterioration and rehospitalization) were stayed. Results: The frequency of PP and PP3 was 40.6 and 16.9%, respectively.The median of the IC and ICE score were 2 (0-7) and 4 (0-11), respectively. We found the following independent relations: IC of 3 or greater with the rehospitalization and the length of stay; ICE of 5 or greater with mortality; PP3 with mortality, rehospitalization and emergency visits, hospitalizations and consultations in the last year; the categories B and F of PP with hospitalizations in the last year; the category D of PP with consultations in the last year; and the association of categories A, B and C with mortality and hospitalizations in the last year. PP was not related in an independent form with any variable. Conclusion: The IC and the concept of PP do not identify the same hospitalized patient population. Modifications of the PP definition, like PP3, or the analysis of the different clinical categories of PP and their associations, could improve the utility of this concept

[Prevalence of metabolic syndrome in the province of Albacete (Spain)]. / Prevalencia del síndrome metabólico en la provincia de Albacete.

OBJECTIVE: The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). PATIENTS AND METHODS: A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. RESULTS: Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. CONCLUSIONS: Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome.

Prevalencia del síndrome metabólico en la provincia de Albacete / Prevalence of metabolic syndrome in the province of Albacete (Spain)

Objetivo. El objetivo principal del estudio es determinar la prevalencia del síndrome metabólico (SM) en personas entre 40 y 70 años en la provincia de Albacete. Pacientes y métodos. Se trata de un estudio transversal poblacional en personas entre 40 y 70 años en tres municipios representativos de la provincia de Albacete. La participación total del estudio fue de 425 individuos. La edad media de la muestra fue de 53,1 años (intervalo de confianza [IC] 95%: 52,3-54), con un 50,4% de mujeres y un 49,6% de hombres. A todos los participantes se les realizó una analítica general y una exploración física con medición de parámetros antropométricos. El SM se definió según los criterios del Adult Treatment Panel-III (ATP-III). En el análisis estadístico se calculó la prevalencia del SM, así como su distribución según sus características epidemiológicas. Resultados. La prevalencia total del SM fue del 20,9% (88/421), con una edad media de 57 años (IC 95%: 55,1-59). Su prevalencia aumenta con la edad, siendo de hasta un tercio de la población mayor de 60 años. Por otra parte, se han encontrado diferencias significativas con antecedentes de cardiopatía isquémica, elevación de la proteína C reactiva ultrasensible y la detección de microalbuminuria en los pacientes con SM. La hipertensión arterial y la obesidad abdominal fueron los criterios más prevalentes en los pacientes con SM. Conclusiones. Teniendo en cuenta la importante comorbilidad que este síndrome conlleva, el conocimiento de su prevalencia y sus características en nuestro medio, así como su identificación y la intervención precoz sobre los distintos factores que la componen, contribuirían a una disminución de eventos cardiovasculares que se relacionan con este síndrome

Objective. The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). Patients and methods. A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. Results. Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. Conclusions. Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome

[Comorbidity, pluripathology, resource use and prognosis of patients hospitalized in internal medicine areas]. / Comorbilidad, pluripatología, consumo de recursos y pronóstico de pacientes ingresados en una unidad de Medicina Interna.

OBJECTIVE: To compare the concept of patient with pluripathology (PP) with the index of comorbidity of Charlson (IC) respect to the resources use and prognosis of hospitalized patients. PATIENTS AND METHODS: An observational prospective study of 207 consecutively hospitalized patients in an internal medicine unit was conducted. The PP, a variant of PP with three or more criteria (PP3), IC and IC fit to the age (ICE) were determined, and their relation with the consumption of resources (emergency attentions, programmed consultations of specialties and episodes of hospitalization in the last year, length of stay, own procedures, other specialty procedures and consulting) and prognosis (hospital mortality, significant functional deterioration and rehospitalization) were stayed. RESULTS: The frequency of PP and PP3 was 40.6 and 16.9%, respectively. The median of the IC and ICE score were 2 (0-7) and 4 (0-11), respectively. We found the following independent relations: IC of 3 or greater with the rehospitalization and the length of stay; ICE of 5 or greater with mortality; PP3 with mortality, rehospitalization and emergency visits, hospitalizations and consultations in the last year; the categories B and F of PP with hospitalizations in the last year; the category D of PP with consultations in the last year; and the association of categories A, B and C with mortality and hospitalizations in the last year. PP was not related in an independent form with any variable. CONCLUSION: The IC and the concept of PP do not identify the same hospitalized patient population. Modifications of the PP definition, like PP3, or the analysis of the different clinical categories of PP and their associations, could improve the utility of this concept.

[Descriptive study about physical examination patterns of a Spanish physician's sample]. / Estudio descriptivo sobre patrones de exploración física de una muestra de médicos españoles.

BACKGROUND AND OBJECTIVES: We describe the basic scheme of physical examination (PE) and the patterns of PE by specialties. We compare items explored by internists and family physicians. PATIENTS AND METHOD: A cross-sectional study on the routine physical examination made by a Spanish physician's sample. Seventy-six maneuvres were analysed by a table of frequencies obtaining physical examination patterns by specialties. RESULTS: A total of 131 physicians of 140 answered the questionnaire (93.5%). They corresponded to Internal Medicine (48.1%), Family and General Medicine (32.1%), other specialties (19.8%). Average age of responders was 37.8 years (Confidence Interval [CI] 95%: 36.3-39.4) and years of experience average were 11.9 (CI 95%: 10.4-13.5). The pattern of general examination used by more than 70% of the physicians surveyed includes maneuvres related to the general examination, respiratory, cardio-circulatory, gastro-intestinal and neurological systems examination. Internists explore weight, temperature, cardiac rate, arterial pressure, neck, jugular ingurgitation, respiratory, abdominal and lymphatic system more often than family physicians (p<0.05). Family physicians perform otoscopy and nose, conches and nasal septum inspection more often than internists (p<0.05). CONCLUSIONS: PE is a flexible tool physicians adapt to their needs based on the specialty they have. Internists are the specialists who make a more exhaustive physical examination compared with family physicians and other specialists.

Hematoquecia por úlcera de Dieulafo y colónica en paciente con valvulopatía mitral intervenida y gastritis crónica atrófica / Lower gastrointestinal bleeding by Dieulafoy colonic ulcer in patient with mitral valvulopathy and athropic chronic gastritis

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Radiografía de tórax

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