Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca / Epidemiological events related to decompensated heart failure

Objetivo: El presente estudio pretende conocer el perfil del paciente que ingresa por descompensación de insuficiencia cardíaca en un hospital de tercer nivel asistencial. Métodos: Se diseña un estudio observacional y retrospectivo en el que se registra de forma aleatoria los ingresos por este proceso en nuestro centro durante el año 2005. Resultados: El tamaño muestral es de 209 pacientes (media de edad: 78,6 ± 9,1; 52,4% varones), con un índice de comorbilidades del 87,55%. Casi un tercio de los pacientes no disponen de valoración de la función sistólica y entre los restantes, la gran mayoría (72,4%) presentan función sistólica conservada. La gran mayoría de las descompensaciones surgen en el seno de infecciones respiratorias. La cardiopatía isquémico-hipertensiva es el origen más frecuente de la cardiopatía con disfunción sistólica. Se registró una estancia hospitalaria media de 12,9 días con un índice de mortalidad del 9,56% resultando sus principales factores de riesgo estadíos funcionales avanzados en las escalas de la NYHA o de la Cruz Roja así como la presencia de demencia o ictus. Conclusiones: El presente estudio muestra un perfil del paciente hospitalizado por descompensación de insuficiencia cardíaca que difiere notablemente de aquel incluído en los grandes ensayos clínicos, lo que sin duda dificulta la aplicación de estrategias terapéuticas que han demostrado ser útiles en aquellos casos

Objective: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. Methods: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. Results: 209 patients were collected (average age: 78.6 ± 9.1; male:52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology ofsystolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. Conclusions: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful

[Epidemiological events related to decompensated heart failure]. / Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca.

OBJECTIVE: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. METHODS: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. RESULTS: 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. CONCLUSIONS: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.

Epidemiología de la insuficiencia cardiaca. Proporciones de epidemia / Epidemiology of heart failure. Ratio of epidemic

La Insuficiencia Cardíaca (IC) es un síndrome complejo, con una alta prevalencia en la población, situándose en torno al 10% en mayores de 70 años, y esta continúa aumentando. Su incidencia en mayores de 65 años es del 1% al año. En países desarrollados es la primera causa de hospitalización en mayores de 65 años, suponiendo el 5% del total de ingresos, y su porcentaje se incrementa cada año. La mayoría de los autores reconoce que las cifras alcanzan valores de epidemia, si bien es cierto que debido a su complejidad no es fácil de definir ni de cuantificar. Aunque la supervivencia ha mejorado en los últimos años, continúa teniendo un mal pronóstico con una mortalidad aproximada del 50% a los 5 años del diagnóstico. Debido a su elevada prevalencia y a su alta tasa de ingresos-reingresos supone un problema de salud pública por su elevada carga asistencial. En conjunto se estima que los costes directos de la IC suponen 1-2% del presupuesto sanitario de los países desarrollados

The Heart Failure is a complex sindrom with a high prevalence in the population, being about 10% in older than 70 years and it is continuosly increasing . Its incidence in persons older than 65 years is about 1% per year. In developed countries it is the first cause of hospitalitation in older than 65 years, supposing the 5% of total admissions and it is increasing every year. The most of authors recognise that the numbers reach values of epidemic, although it is true that it is difficult to determine and cuantify due to its complexity. Although the supervivence has improved in last years, it continues being in a bad pronostic with a mortality about 50% after 5 years approximately of the diagnostic . In order to its high prevalence and its high rate of admissions-readmissions it supposes a problem of public health due to high assistance work. Globally it is estimated that the direct costs of heart failure suppose 1-2 % of healthy cost of developed countries

[Epidemiology of heart failure. Ratio of epidemic]. / Epidemiología de la insuficiencia cardiaca. Proporciones de epidemia.

The Heart Failure is a complex sindrom with a high prevalence in the population, being about 10% in older than 70 years and it is continuosly increasing . Its incidence in persons older than 65 years is about 1% per year. In developed countries it is the first cause of hospitalitation in older than 65 years, supposing the 5% of total admissions and it is increasing every year. The most of authors recognise that the numbers reach values of epidemic, although it is true that it is difficult to determine and cuantify due to its complexity. Although the supervivence has improved in last years, it continues being in a bad pronostic with a mortality about 50% after 5 years approximately of the diagnostic . In order to its high prevalence and its high rate of admissions-readmissions it supposes a problem of public health due to high assistance work. Globally it is estimated that the direct costs of heart failure suppose 1-2 % of healthy cost of developed countries.

Use of ligase chain reaction for the rapid diagnosis of lymph node tuberculosis.

Ligase chain reaction amplification (LCx Abbott Laboratories) was used to detect the presence of M. tuberculosis in 101 adenopathy specimens obtained from 98 patients. A total of 30 cases of lymph node tuberculosis were diagnosed, and the data were compared with results obtained using conventional techniques. The sensitivity of auramine staining and culture were 50.0% and 66.7%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the LCx assay were 80.0, 98.6, 96.0, and 92.1% respectively. The results confirm the reliability of ligase chain reaction amplification for the detection of lymph node tuberculosis.

[Statin-induced rhabdomyolysis and renal failure: also with fluvastatine]. / Rabdomiolisis y fallo renal por estatinas: también con fluvastatina.

Hydroximetilglutaril-coenzima A reductase inhibitors (statin) have the potential to cause rhabdomyolysis. However, fluvastatin is rarely associated with rhabdomyolysis when compared to other statins. Differences in biochemical and pharmacokinetic properties between fluvastatin and the other statins have been invocated in order to explain the apparent comparative safety of fluvastatin. We present a case of rhabdomyolysis with acute renal failure in a patient receiving fluvastatin and, following the Karch-Lasagne algorithm, we present evidence that this case was an adverse reactions to fluvastatin.

Rabdomiolisis y fallo renal por estatinas: también con fluvastatina / Statin-induced rhabdomyolysis and renal failure: also for fluvastatine

La rabdomiolisis es un efecto adverso plenamente descrito para los inhibidores de la Hidroximetil-glutaril Coenzima A reductasa (estatinas). Sin embargo la evidencia de esta asociación es menor para la fluvastatina y se ha argumentado que sus diferencias bioquímicas y farmacocinéticas con el resto de estatinas explicaría esta aparente inocuidad comparativa. Presentamos un caso de rabdomiolisis con fallo renal en una paciente que recibía tratamiento con fluvastatina y, mediante el algoritmo de causalidad de reacciones adversas de Karch y Lasagna, proporcionamos evidencia de que se trata de una efecto adverso atribuible a la fluvastatina (AU)