[Impact of delayed discharge for nonmedical reasons in a tertiary hospital internal medicine department]. / Retraso del alta hospitalaria por motivos no médicos.

BACKGROUND: Delayed discharge occurs from a clinical point of view when a patient is considered medically fit for discharge but continues occupying a bed due to a nonmedical problem. This circumstance overloads the care system, however, its real frequency and loss of useful days of hospitalization have not being evaluated in Spain up to date. OBJECTIVE: To analyze the frequency of hospital delayed discharges due to non-medical reasons in a tertiary hospital Internal Medicine Department and to determine the clinical and socio-familial factors related to this situation. PATIENTS AND METHODS: An observational and prospective study was performed to analyze the characteristics of the patients whose discharge was delayed for nonmedical reason over a 12-month period. RESULTS: There were 4850 discharges in the Internal Medicine Department, 170 (3.5%) of which were delayed because of nonmedical problems. This accounted for a loss of 1603 useful days of hospitalization for other patients within one year. The median delay was 5 days (range: 3-12). Patients with delayed discharges were elder and had a higher prevalence of acute cerebrovascular disease as well as alcohol or benzodiazepines use related problems. The main causes were the overload or inability of the family to care for the patient and the impossibility to combine patient care with the family's working life (51.8%), and lack of family or social support network (21.8%). CONCLUSIONS: Delayed discharges for nonmedical reasons are frequent and mainly motivated by social-familiar problem to take charge of the patients after their hospitalization. This accounts for a significant overload for the hospitals.

Note: Determination of torsional spring constant of atomic force microscopy cantilevers: combining normal spring constant and classical beam theory.

A technique has been developed for the calculation of torsional spring constants for AFM cantilevers based on the combination of the normal spring constant and plate/beam theory. It is easy to apply and allow the determination of torsional constants for stiff cantilevers where the thermal power spectrum is difficult to obtain due to the high resonance frequency and low signal/noise ratio. The applicability is shown to be general and this simple approach can thus be used to obtain torsional constants for any beam shaped cantilever.

Denture stomatitis: quantification of interleukin-2 production by mononuclear blood cells cultured with Candida albicans.

Denture stomatitis is usually associated with the presence of yeast, particularly Candida albicans, and several bacteria. In this study mononuclear blood cells were grown in the presence of Candida albicans from a single colony, and interleukin-2 production induced in T lymphocytes was measured. Blood cells were from a population of patients with denture stomatitis and a control group of denture wearers without stomatitis. Induction of interleukin-2 production was correlated with factors that condition denture stomatitis, namely, isolation of Candida albicans in selective medium, age of the denture, and diabetes. Concentrations of interleukin-2 in supernatant and serum were also compared. Significant differences in interleukin-2 production were found between patients with denture stomatitis and controls. Statistical analysis demonstrated a significant association between isolation of Candida albicans and elevated interleukin-2 production in cultures from patients with and without denture stomatitis.

Induction of interleukin-1 alpha production by Porphyromonas gingivalis in mononuclear blood cell cultures from periodontitis patients.

The capacity of mononuclear blood cells to produce interleukin-1 alpha (IL-1 alpha) after stimulation with Porphyromonas gingivalis in cell culture was studied. The results obtained with cells from periodontitis patients were compared with those from a control population. The concentration of IL-1 alpha in serum and saliva was also determined and compared with the concentration in mononuclear blood cell cultures. No significant relationship was found between the incidence of periodontitis or severity of the lesions and IL-1 alpha production in the presence of P. gingivalis. Nevertheless, 11 of 30 periodontitis patients, showed levels > 30 pg/ml of IL-1 alpha in mononuclear blood cell cultures stimulated by P. gingivalis, whereas only three healthy control showed these titers of IL-1 alpha.

Carcinoma hepatocelular: análisis clínico de 16 casos consecutivos / Hepatocellular carcinoma: clinical analysis of 16 consecutives cases

Se analizan los pacientes atendidos con diagnóstico de tumor hepático entre los meses de mayo de 1993 y mayo de 1994. A éstos se les efectuó anamnesis y examen físico detallados, estudio de laboratorio general y función hepática, determinación de alfafetoproteína y marcadores virales para hepatitis B y C. Se etapificó a los pacientes desde el punto de vista pronóstico según Okuda y cols. y el performance status. Durante el período analizado se diagnosticaron 16 pacientes con hepatocarcinoma con una media etaria de 57.8 años. Signos frecuentes fueron: masa palpable (50 por ciento) y baja de peso (25 por ciento). El status performance fue I o II en el 63 por ciento de los casos y según clasificación de Okuda el 63 por ciento de los pacientes se encontraban en estadio II. El laboratorio general sólo permitió constatar un incremento en las cifras de transaminasas y fosfatasa alcalina, el resto de los parámetros fueron normales