Anticuerpos contra el SARS-CoV-2 tras la dosis de vacuna de recuerdo. Identificación de subgrupos con respuesta insuficiente / SARS-CoV-2 antibodies after booster vaccination. Identification of subgroups with poor response

Objetivo Identificar dentro del grupo de pacientes de alto riesgo a aquellos que presentan más posibilidad de presentar inmunidad postvacunal insuficiente. Método Determinación de títulos de IgG frente a SARS-CoV-2 después de la dosis de recuerdo. Se clasificó la respuesta vacunal como negativa (títulos IgG <34 BAU/ml), indeterminada (títulos 34 - 259 BAU/ml) o positiva (≥260 BAU/ml). Resultados Se incluyeron 765 pacientes (31,25% de los vacunados): 54 (7,1%) en tratamiento con fármacos biológicos, 90 (11,8%) con enfermedad hematológica, 299 (39,1%) con patología oncológica, 304 (39,7%) con trasplante de órgano sólido y 18 (2,4%) con inmunosupresión por otros motivos. Un total de 74 pacientes (9,7%) tuvieron una serología negativa y 45 (5,9%) obtuvieron títulos indeterminados. Por grupo diagnóstico, los pacientes con mayor porcentaje de serología negativa o indeterminada fueron pacientes bajo tratamiento con fármacos biológicos (55,6%, fundamentalmente a expensas de antiCD20), hematológicos (35,4%) y los trasplantados (17,8%, principalmente pulmón y riñón). Los pacientes oncológicos y otros pacientes inmunosuprimidos tuvieron buena respuesta vacunal. Conclusión Los pacientes tratados con fármacos antiCD20, los hematológicos y los trasplantados (fundamentalmente de pulmón y riñón) presentaron mayor riesgo de no desarrollar inmunidad postvacunal. Es fundamental su identificación de cara a individualizar y mejorar su manejo (AU)

Objective To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. Methods Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers <34 BAU/ml), indeterminate (titers 34 - 259 BAU/ml) or positive (≥ 260 BAU/ml). Results 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. Conclusion Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management (AU)

[SARS-CoV-2 antibodies after booster vaccination. Identification of subgroups with poor response]. / Anticuerpos contra el SARS-CoV-2 tras la dosis de vacuna de recuerdo. Identificación de subgrupos con respuesta insuficiente.

Objective: To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. Methods: Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34 - 259 BAU/ml) or positive (≥ 260 BAU/ml). Results: 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. Conclusion: Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

SARS-COV-2 antibodies after booster vaccination. Identification of subgroups with poor response.

OBJECTIVE: To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity. METHODS: Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34-259 BAU/ml) or positive (≥260 BAU/ml). RESULTS: 765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination. CONCLUSION: Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

[Health-related quality of life in patients recovered from COVID-19]. / Calidad de vida relacionada con la salud en pacientes recuperados de COVID-19.

INTRODUCTION: The presence of symptoms after acute SARS-CoV-2 infection is frequent and has an impact on patients' quality of life. The aim of this study is to assess the health-related quality of life of COVID-19 survivors and to ascertain which factors are related to worse results. METHODS: An observational, cross-sectional study has been performed, using, a telephone survey that was administered to all patients with COVID-19 from the first pandemic wave in our healthcare area 10months after the acute infection. Patients with dementia and nursing home residents were excluded. Health-related quality of life was assessed using the EQ-5D instrument and its índices EQ-VAS and EQ-Health Index. RESULTS: 443 answers were collected. Mean age was 54±16 and 38.4% of patients were male. The most affected domain was anxiety/depression (23.9% of patients) and mobility (16.5%). Mean global EQ-VAS score was 75.8±18.7, and mean EQ-Health Index was 0.884±0.174. Both VAS and Health Index scores were lower in females, patients older than 65 years, patients with comorbidities, and those who needed hospital admission during the acute infection. VAS scores in our sample were lower than in the general Spanish population, but similar to the scores in our region prior to the pandemic. Female sex, hospital admission, and a lower educational status were independently associated to lower EQ-Health Index scoring. CONCLUSION: While health self-perception is affected after COVID-19, this might not be directly related to the infection. There exist profiles of patients more prone to a worse quality of life in which interventions may be considered.

Mujer de 41 años con lesiones cutáneas / 41 Year old woman with skin lesions

La lepra o enfermedad de Hansen, es una entidad nosológica infecciosa producida por Mycobacterium leprae. No se conoce exactamente su mecanismo de transmisión. Es más frecuente en hombres y aparece habitualmente entre la segunda y tercera década de la vida. El diagnóstico de lepra es clínico, sin embargo la presencia de los bacilos en frotis y biopsias cutáneas y la detección de su ADN permiten su confirmación. El tratamiento es largo y la curación se consigue tras varios años sin enfermedad. Presentamos un caso de lepra autóctono atendido en nuestro centro. Mujer de 41 años de edad, española, agricultora que consulta por presentar lesiones cutáneas redondeadas, con centro deprimido, eritematodescamativas en el borde y acompañadas de unas lesiones cutáneas nodulares en miembros inferiores. Se decidió biopsiar las lesiones nodulares que confirmaron el diagnóstico de lepra. Se inició tratamiento y las lesiones cutáneas evolucionaron favorablemente hasta su resolución. Actualmente existen dos casos de lepra activos y tres en vigilancia tras el tratamiento. En Galicia es poco habitual, y casi siempre está en relación con población inmigrante

Leprosy or Hansen's disease is an infectious nosological entity produced by Mycobacterium leprae. Its transmission mechanism is not known exactly. It is more common in men and usually appears between the second and third decade of life. The diagnosis of leprosy is clinical, however the presence of bacilli in smears and skin biopsies and the detection of their DNA allow their confirmation. The treatment is long and the cure is achieved after several years without disease. We present a case of autochthonous leprosy attended in our center. A 41-year-old Spanish woman, a farmer who consulted due to rounded skin lesions, with a depressed center, erythematodescampathetic on the edge and accompanied by nodular skin lesions on the lower limbs. It was decided to biopsy the nodular lesions that confirmed the diagnosis of leprosy. Treatment was started and the skin lesions evolved favorably until their resolution. Currently there are two cases of active leprosy and three in surveillance after treatment. In Galicia it is unusual, and it is almost always related to the immigrant population

Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna / Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine

Objetivo: Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atención clínica requerida y cuantificar la carga de trabajo que supone. Material y método: Estudio multicéntrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del año 2016. Se estimó la carga de trabajo relacionada con dicha actividad (1UT=10min). Resultados: Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) años, 51,2% hombres. El índice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta más frecuentes fueron: valoración general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabólico (9,6%), HTA (6,3%) y síndrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirúrgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p=0,0001) y precisaron más días de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p=0,009). Los siguientes aspectos fueron más frecuentes en el formato de las IC realizadas por servicios médicos: número de IC ordinarias (respuesta >24h), especificación del motivo de IC, datos mínimos referentes a la historia clínica y coincidencia de la adecuación en el tiempo con el consultor. Conclusión: Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuación al formato de solicitud de IC es mayor en las procedentes de servicios médicos

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format

Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine. / Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna.

OBJECTIVE: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. MATERIAL AND METHOD: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). RESULTS: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. CONCLUSION: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.

Paralysis of the external popliteal sciatic nerve associated with daptomycin administration.

WHAT IS KNOWN AND OBJECTIVE: Peripheral neuropathy has been associated with the administration of certain drugs. Few reports have described the association of daptomycin with the development of peripheral neuropathy, none of them with peroneal nerve involvement. CASE SUMMARY: We report a case of a 62-year-old man who developed external popliteal sciatic nerve paralysis after 22 days of therapy with daptomycin. WHAT IS NEW AND CONCLUSION: We present an uncommon and not previously reported adverse event. We have also analysed a possible alteration in a metabolic pathway (ABCB1 gene polymorphisms) that, in some patients, could explain certain drug adverse events. WHAT IS NEW AND CONCLUSION: We present an uncommon and not previously reported adverse event. We have also analysed a possible alteration in a metabolic pathway (ABCB1 gene polymorphisms) that, in some patients, could explain certain drug adverse events.

Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome. / Factores epidemiológicos y sociodemográficos asociados al síndrome de abstinencia alcohólica complicado.

OBJECTIVES: To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). MATERIAL AND METHODS: A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens. RESULTS: We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793). CONCLUSIONS: Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS.

Síndrome de abstinencia alcohólica en pacientes hospitalizados / Inpatient alcohol withdrawal syndrome

Un varón de 55 años ingresó por fractura de fémur. A su llegada presentaba fétor enólico. Al día siguiente comenzó con temblor y nerviosismo, por lo que se administró haloperidol por vía intravenosa. Poco después presentó dos crisis comiciales generalizadas y posteriormente desarrolló un delirio con agresividad incontrolable. Se planteó el diagnóstico de síndrome de abstinencia alcohólica y se pautó midazolam por vía intravenosa en perfusión a dosis altas. A las pocas horas evolucionó a depresión respiratoria que obligó a su traslado a la Unidad de Cuidados Intensivos. Revisados sus antecedentes, el enfermo había ingresado en tres ocasiones previas por síndrome de abstinencia alcohólica, que tras presentar crisis comiciales evolucionó a delirium tremens. ¿Se podía valorar al ingreso el riesgo de desarrollar un síndrome de abstinencia alcohólica y la necesidad de profilaxis farmacológica? ¿Se utilizaron las medidas de control y tratamiento adecuadas? ¿Hubiera sido posible modificar su evolución clínica? (AU)

A 55-year-old man was admitted for a femur fracture; an alcohol fetor was noted on admission. The following day, the patient began to experience tremors and nervousness. Intravenous haloperidol was administered. Shortly afterwards, the patient experienced two generalized seizures and then began to experience delirium and uncontrollable agitation. The patient was diagnosed with alcohol withdrawal syndrome; high doses of intravenous midazolam were prescribed and infused. A few hours later, the patient presented signs of respiratory depression, requiring a transfer to the intensive care unit. After a review of the medical history, it was determined that the patient had been admitted on 3 previous occasions due to alcohol withdrawal and had progressed to delirium tremens after experiencing seizures. Can the risk of alcohol withdrawal syndrome and the need for prophylactic treatment be assessed on admission? Were appropriate monitoring and treatment measures employed? Would it have been possible to change his outcome? (AU)

Inpatient alcohol withdrawal syndrome. / Síndrome de abstinencia alcohólica en pacientes hospitalizados.

A 55-year-old man was admitted for a femur fracture; an alcohol fetor was noted on admission. The following day, the patient began to experience tremors and nervousness. Intravenous haloperidol was administered. Shortly afterwards, the patient experienced two generalized seizures and then began to experience delirium and uncontrollable agitation. The patient was diagnosed with alcohol withdrawal syndrome; high doses of intravenous midazolam were prescribed and infused. A few hours later, the patient presented signs of respiratory depression, requiring a transfer to the intensive care unit. After a review of the medical history, it was determined that the patient had been admitted on 3 previous occasions due to alcohol withdrawal and had progressed to delirium tremens after experiencing seizures. Can the risk of alcohol withdrawal syndrome and the need for prophylactic treatment be assessed on admission? Were appropriate monitoring and treatment measures employed? Would it have been possible to change his outcome?

Análisis de la situación laboral actual de los especialistas en Medicina Interna formados en Galicia en los últimos 5 años / Analysis of the current employment situation of Internal Medicine specialists trained in Galicia in the last 5 years

No disponible

Review of use of drugs for conditions not included in product characteristics.

Off-label use of medication is common in hospital clinical practice and should be applied together with follow-up of a healthcare treatment protocol and in compliance with a procedure which ensures that the patient is informed and that he or she provides informed consent. A review of the literature on controlling 310 disorders showed that off-label use was indicated for 69 of them (22.3%) with the minimum required scientific evidence. It would be useful for the Pharmacy and Therapeutics Committee to have a list of the disorders that can be controlled using off-label drugs, providing a reference to those disorders which must follow a healthcare treatment protocol. A list of the mentioned characteristics is also useful for the hospital pharmacist for validating prescriptions, as it would provide a reference for assessing prescriptions which at first sight could seem questionable. Finally, this list would be very useful if a search index of all the drugs by disorder were to be included in the Pharmacotherapeutic Guide. It would complement the usual indices which include active ingredients and specialties.

Factores de riesgo para la presentación de complicaciones médicas en enfermos con fractura de cadera / Risk factors for the development of medical complications in patients with hip fracture

Objetivo. Analizar las características de los pacientes hospitalizados con fractura de cadera y su evolución clínica, así como evaluar qué factores se asocian a un mayor riesgo de complicaciones médicas durante el ingreso. Métodos. Estudio prospectivo de los enfermos mayores de 65 años ingresados con fractura de cadera en el Servicio de Traumatología del Complexo Hospitalario Xeral-Calde de Lugo durante el año 2008. Se recogieron diferentes datos clínicos analíticos relativos al estado basal de salud, las características de la fractura y las complicaciones hospitalarias. Se determinaron los factores asociados al desarrollo de la variable compuesta por aparición de complicaciones médicas mayores o fallecimiento durante el ingreso hospitalario, mediante análisis univariable y multivariable. Resultados. Se estudió a 258 pacientes, media (DE) de edad 82,2 (9,5) años, el 76% mujeres. La fractura fue osteoporótica en el 96,8% y fueron operados el 92,6% de los enfermos. El índice de Barthel medio fue 72,9 (25,7) y el de comorbilidad de Charlson medio ajustado por edad 5,2 (1,5). El 63,9% presentó alguna complicación médica mayor durante el ingreso hospitalario. Fallecieron 15 enfermos (5,8%). Las siguientes variables se asociaron al riesgo de aparición de complicaciones médicas: índice de Barthel (OR=2,21; IC del 95%, 1,1-4,25; p=0,01), edad (OR=1,09; IC del 95%, 1,02-1,12; p=0,006), hemoglobina al ingreso (OR=0,76; IC del 95%, 0,62-0,93; p=0,01). Conclusiones. Los enfermos con fractura de cadera son ancianos frágiles, con un importante grado de dependencia y comorbilidad. Es posible identificar al ingreso a aquellos con un mayor riesgo de presentar complicaciones médicas durante su estancia hospitalaria(AU)

Objective. To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications. Methods. Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses. Results. A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01). Conclusions. Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission(AU)

[Risk factors for the development of medical complications in patients with hip fracture]. / Factores de riesgo para la presentación de complicaciones médicas en enfermos con fractura de cadera.

OBJECTIVE: To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications. METHODS: Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses. RESULTS: A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01). CONCLUSIONS: Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission.

[Clinical course and features of the alcohol withdrawal syndrome in a general hospital]. / Manifestaciones y curso clínico del síndrome de abstinencia alcohólica en un hospital general.

INTRODUCTION: Despite its frequency and high clinical burden, few studies have analyzed the clinical features of the alcohol withdrawal syndrome in a hospital setting. Our purpose was to describe its manifestations and clinical course in a general hospital. PATIENTS AND METHODS: Patients with a diagnosis of alcohol withdrawal since January 1983 to December 2003, according to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders criteria, at the Xeral-Calde General Hospital in Lugo, were studied. Clinical and biochemical data at admission were collected, as well as those referred to the clinical course and complications. RESULTS: 539 episodes in 436 patients were included. Mean age was 45 (standard deviation: 12), and 91,3% were men. Abstinence was the reason for admission in 62,3%. 71,1% had a diagnosis of delirium tremens during their stay. Hallucinations were present in 59,7%, and convulsions (most of them generalized) in 41%. Patients with delirium tremens had greater elevations in temperature, heart rate and blood pressure, as well as more convulsions than minor withdrawal cases. Cirrhosis was present in 10%. The admission rate to the Intensive Care Unit (ICU) was 37,8% (95% confidence interval [95%IC]: 33,1-37,8). Of these, 69,9% needed mechanical ventilation. Mortality rate was 6,6% (95%IC: 4,2-9,1). 62% of patients died after admission in the ICU. CONCLUSION: The majority of complications related to the alcohol withdrawal syndrome in a hospital setting develop in patients with delirium tremens. They are especially related to the rate of admissions to the ICU and the use of mechanical ventilation.

Manifestaciones y curso clínico del síndrome de abstinencia alcohólica en un hospital general / Clinical course and features of the alcohol withdrawal syndrome in a general hospital

Introducción. A pesar de la elevada frecuencia delsíndrome de abstinencia alcohólica en el ámbitohospitalario y su gran impacto clínico, pocos estudioshan analizado sus características. El objetivo de esteestudio fue describir su forma de presentación yevolución clínica en un hospital general.Pacientes y métodos. Se estudiaron los enfermosdiagnosticados de síndrome de abstinenciaalcohólica según los criterios de la cuarta ediciónrevisada del Manual diagnóstico y estadístico delos trastornos mentales, en el ComplexoHospitalario Xeral-Calde de Lugo entre enero de1987 y diciembre de 2003. Se registraron loshallazgos clínicos y analíticos presentes en elmomento del ingreso, así como la evolución clínica ylas complicaciones sufridas durante su estancia.Resultados. Se registraron 539 episodios en 436pacientes. La edad media fue de 45 años (desviaciónestándar: 12), y el 91,3% eran hombres. Laabstinencia fue el motivo de ingreso en el 62,3% delos casos. Al final del ingreso hospitalario secontabilizó un 71,1% con síndrome mayor deabstinencia. El 59,7% presentó alucinaciones y el41%, crisis epilépticas, casi en su totalidad de tipogran mal. Los pacientes con delirium tremenspresentaron mayores elevaciones de temperatura,frecuencia cardíaca y tensión arterial, así como unamayor incidencia de crisis. El 10% presentaba cirrosis.La tasa de traslados a la Unidad de CuidadosIntensivos (UCI) fue del 37,8% (intervalo de confianzaal 95% [IC95%]: 33,1-37,8). De éstos, el 69,6%precisó una intubación orotraqueal. La tasa demortalidad fue del 6,6% (IC95%: 4,2-9,1). El 62% delos fallecimientos se produjo tras su ingreso en la UCI.Conclusión. Las complicaciones relacionadas con elsíndrome de abstinencia alcohólica en un hospitalgeneral se concentran en los casos de deliriumtremens, especialmente en los pacientes trasladadosa la UCI y conectados a ventilación mecánica

Introduction. Despite its frequency and high clinicalburden, few studies have analyzed the clinicalfeatures of the alcohol withdrawal syndrome in ahospital setting. Our purpose was to describe itsmanifestations and clinical course in a generalhospital.Patients and methods. Patients with a diagnosis ofalcohol withdrawal since January 1983 to December2003, according to the revised fourth edition ofthe Diagnostic and Statistical Manual of MentalDisorders criteria, at the Xeral-Calde GeneralHospital in Lugo, were studied. Clinical andbiochemical data at admission were collected, aswell as those referred to the clinical course andcomplications.Results. 539 episodes in 436 patients wereincluded. Mean age was 45 (standard deviation: 12),and 91,3% were men. Abstinence was the reasonfor admission in 62,3%. 71,1% had a diagnosis ofdelirium tremens during their stay. Hallucinationswere present in 59,7%, and convulsions (most ofthem generalized) in 41%. Patients with deliriumtremens had greater elevations in temperature,heart rate and blood pressure, as well as moreconvulsions than minor withdrawal cases. Cirrhosiswas present in 10%. The admission rate to theIntensive Care Unit (ICU) was 37,8% (95%confidence interval [95%IC]: 33,1-37,8). Of these,69,9% needed mechanical ventilation. Mortality ratewas 6,6% (95%IC: 4,2-9,1). 62% of patients diedafter admission in the ICU.Conclusion. The majority of complications relatedto the alcohol withdrawal syndrome in a hospitalsetting develop in patients with delirium tremens.They are especially related to the rate of admissionsto the ICU and the use of mechanical ventilation