Fiebre Q aguda: riesgo de desarrollo de endocarditis / Acute Q fever and the risk of developing endocarditis

Objetivo: Valorar los datos clínicos y serológicos como parámetros indicativos de posible evolución a endocarditis tras un episodio de fiebre Q aguda. Pacientes y métodos: Estudio de cohortes retrospectivo de la evolución a endocarditis tras un episodio de fiebre Q aguda, analizando evolución clínica, serológica y tratamiento antibiótico recibido. Resultados: Se reclutó a 80 pacientes, presentando el 20% niveles de anticuerpos IgG de fase I ≥ 1:1.024 en los primeros 3 meses. Solo el 44% recibió antibioterapia en la fase aguda; únicamente 2 enfermos recibieron antibioterapia prolongada. Se realizó ecocardiograma al 15%. Ningún paciente presentó síntomas indicativos de infección crónica ni evolucionó a endocarditis tras una mediana de seguimiento de 100 meses, independientemente de la elevación precoz de anticuerpos IgG de fase I. Conclusiones: La elevación precoz de anticuerpos IgG fase I no se asoció a evolución a endocarditis a pesar de no haberse realizado tratamiento antibiótico prolongado en pacientes asintomáticos (AU)

Objectives: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. Patients and methods: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. Results: Eighty patients were recruited, 20% of whom had phase I IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase I IgG antibodies. Conclusions: The early increase in phase I IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment (AU)

Acute Q fever and the risk of developing endocarditis. / Fiebre Q aguda: riesgo de desarrollo de endocarditis.

OBJECTIVES: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. PATIENTS AND METHODS: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. RESULTS: Eighty patients were recruited, 20% of whom had phase i IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase i IgG antibodies. CONCLUSIONS: The early increase in phase i IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment.

[Infections by Epstein-Barr virus and cytomegalovirus]. / Infecciones por el virus de Epstein-Barr y citomegalovirus.

Infections by Epstein-Barr virus is the most common cause of infectious mononucleosis. We describe the diagnosis and different serological patterns, as well as its major complications related to the development of malignancies, lymphoproliferative disorders and autoimmune diseases. There is no effective treatment. Cytomegalovirus is the second cause of mononucleosis syndrome and the first of congenital infection in our environment. It has an high morbidity and mortality in immunocompromised patients, mainly solid organ transplants, bone marrow and coinfection by human immunodeficiency virus. Its treatment is based on antivirals, mainly ganciclovir and valganciclovir. We describe its management, adverse effects, new drugs and prophylaxis.

Rotación opioide a oxicodona: éxito en un caso de dolor neuropático / No disponible

El dolor es un síntoma común en pacientes con cáncer y el dolor neuropático está entre los tipos más difíciles de tratar. Los opioides han tenido un papel limitado en el tratamiento del dolor neuropático. Asociados aantidepresivos tricíclicos o a anticonvulsivantes han logrado un mayor alivio de este tipo de dolor pero su uso está a menudo limitado por sus efectos secundarios indeseables. Presentamos un caso de tumor de pulmón con dolor neuropático producido por compresión medular que fue tratado con éxito con oxicodona (AU)

Pain is a common symptom in patients with cancer and neuropathic pain is among the most difficult to treat type. Opioid treatment has played a limited role in the management of neuropathic pain. Opioids associated to tryciclic antidepressants or anticonvulsants have demonstrated a better relief of this type of pain but their use is limited by unwanted side effects. We report a case of a lung tumour with related neuropathic pain from spinal cord compression which was treated successfully with oxycodone (AU)

Ingresos hospitalarios entre los pacientes atendidos por una Unidad de Cuidados Paliativos domiciliarios / No disponible

Introducción: los pacientes atendidos por Unidades Domiciliarias de Cuidados Paliativos (UCPD) con frecuencia precisan ingreso hospitalario. Objetivos: estudio de las causas que motivan el ingreso de pacientes incluidos en un programa de atención domiciliaria de Cuidados Paliativos en una Unidad Hospitalaria de Cuidados Paliativos (UHCP). Método: estudio retrospectivo de las historias clínicas de pacientes atendidos por la UCPD de Cádiz que ingresaron en la UHCP del Hospital Universitario Puerta del Mar de Cádiz. Resultados: durante el periodo de estudio (dos años) se produjeron 140 ingresos correspondientes a 105 pacientes de los 237 incluidos en el programa (44,30%). Los tumores que precisaron ingreso con más frecuencia fueron los de pulmón (33,33%), mama (12,38%) y colon (9,52%). La disnea fue la principal causa de ingreso (32,38%), seguido por la claudicación familiar (18,10%) y la realización de pruebas diagnóstico-terapéuticas (17,14%). Durante el ingreso fallecieron 85 pacientes (60,71% del total de ingresos). Sólo 32 ingresos fueron indicados por la UCPD. Más de la mitad de los ingresos se produjeron en fin de semana. Conclusiones: a pesar de nuestros esfuerzos un alto porcentaje de pacientes atendidos por una UCPD precisan ingreso hospitalario (AU)

Introduction: patients followed by a Palliative Home Care Team (PHCT) often need a hospital admission. Objectives: to study why patients included in a palliative home care program need hospitalization. Method: a retrospective study. The medical records of patients followed by a PHCT in Cádiz who were hospitalized in the Palliative Care Unit, Hospital Universitario Puerta del Mar were reviewed. Results: for two years we enrolled 237 patients. One hundred and five patients (44.30%) were derived to hospital (total: 140 admissions). Tumors most often found were: lung (33.33%), breast (12.38%), and colon (9.52%) tumors. Dyspnea was the main cause of hospitalization (32.38%), followed by giving up (18.10%) and diagnostic or therapeutic procedures (17.14%). During their stay in hospital 85 patients died (60.71% of total hospital admissions). Only 32 admissions were recommended by the PHCT. More than half of hospitalizations occurred in weekends. Conclusions: despite efforts, a high percentage of patients followed b ya PHCT need a hospital admission