Benjamín Herreros

Conocimiento y actitudes ante las instrucciones previas entre los pacientes de un hospital público de la Comunidad de Madrid

INTRODUCTION The level of knowledge and attitudes of patients towards the previous instructions is a little known subject given that their introduction in the Community of Madrid (CM) is recent. AIMS To assess the level of knowledge and implementation of advance directives in patients admitted to an Internal Medicine Service of a public hospital in the CM, the attitudes of patients regarding these documents and their correlation with demographic variables. PATIENTS AND METHODS A cross-sectional study through structured survey of opinion, closed and voluntarily given to all patients admitted in the Internal Medicine Unit of the University Hospital Alcorcon Foundation on the dates May 20 and June 3, 2008 was carried out. RESULTS A total of 155 patients were included, the questions being answered by the patients per se by 57% and by members of theirs families in 42%. Mean age of the patients was 77 years, 50.9% were male and 86.45% were Catholic. Only 7 patients (4.5%) knew what the advance directives were and only one patient had done them. On learning of their existence, 49 patients (31.6%) would like to do the advance instructions. Of the respondents, 80.6% were in favor of having the advance directives document in their medical history and 72.9% do not believe that having these advance directives would change the attitude of their doctor. CONCLUSIONS Although the regulation of advance directives in the Community of Madrid has already been in force for 5 years, little is known about these documents and they are still in a period of diffusion.

¿Por qué dedicarse a la bioética?. Siete razones para comenzar a hacerlo

The aim of clinical bioethics is to promote rational clinical decisions that take into account the clinical facts and the preferences and values of individuals involved in a situation that entails a moral problem. The objective of the present study is to list the reasons why we consider bioethics knowledge and skills to be essential in daily practice and to promote a proactive mindset in clinical bioethics research. The arguments set forth include the need to adapt to changes in the clinical relationship in recent decades, the importance of an ethical approach both for the physician and the patient, the role of bioethics in preventing professional burnout, the ability of ethics to promote a more equitable distribution of resources and the possibility of conducting clinical research in bioethics, a field that has scarcely been explored in Spain.

Recurrent infection in the left thumb

IntroductionInfections of the hand may be associated with lymphangitis and lymphadenitis. In most cases, bacterial infections are responsible but these may be also due to viral infections.Material and MethodsWe describe a clinical case of a recurrent infection in the left thumb of a health male. Bacterial and viral cultures were performed.ResultsHerpes simplex virus (HSV) type 2 was isolated on viral culture and on direct fluorescent antibody testing; so, the final diagnosis was herpetic whitlow.ConclusionsHerpetic whitlow should be considered in cases of recurrent finger infections.

Hemorragia digestiva alta en mujer de 81 años

Upper gastrointestinal bleeding is a frequent syndrome in the elderly that requires urgent attention. The main causes of melenas are peptic ulcer (gastric or duodenal) and esophageal diseases (esophagitis, esophageal varices and Mallory-Weiss syndrome). Unusually, upper gastrointestinal bleeding may be due to a duodenal tumor. Gastrointestinal stromal tumors (GIST) are included in this group. We report the case of an 81-year-old woman who presented with melenas. Gastrointestinal endoscopic studies (upper and lower) revealed no abnormalities, and a duodenal mass was found on thoracic-abdominal computed tomography scan. Urgent surgery due to a massive bleeding episode led to diagnosis of a duodenal GIST.

Miliary Tuberculosis Presenting with Hyponatremia and ARDS in an 82-Year-Old Immunocompetent Female

An immunocompetent 82-year-old female was admitted to our hospital due to fever without clear origin and hyponatremia. In the following days, an acute and bilateral pulmonary infiltrate appeared with a progressive worsening in respiratory function. Chest x-ray and CT (Computed tomography) showed bilateral reticulonodular infiltrates. Bronchoscopic aspiration and bronchoalveolar lavage (BAL), and transbronchial lung biopsy (TBBX) studies did not reveal microbiological and histopathological diagnosis. Broad-spectrum antibiotics were non-effective, and the patient died due to respiratory failure. Necropsy study revealed a miliary tuberculosis affecting lungs, liver, bone marrow, spleen, kidney, arteries, pancreas, and adrenal glands. Some weeks after the patient´s death, mycobacterial cultures from sputum, BAL and TBBX samples were positive for Mycobacterium tuberculosis.

Hand, foot and mouth disease in an adult

A 41-year-old healthy male presented with a 3-day history of high-grade fever (40 °C) followed by painful sores in his mouth, tongue and throat along with odynophagia. Two days after the fever appearance, he felt pain and burning sensation in the distal part of his fingers and toes with appearance of a macular rash in distal parts of both hands. He denied any significant medical or surgical history, having taken medications, and had no allergies. Family history revealed the patient’s 2-year-old daughter recently had H.F.M.D. from an outbreak at her daycare. On physical exam, he presented with an erythematous and swollen pharynx with some sores around the soft palate, tonsils and tongue (Fig. 1) and multiple reddish purpuric macules on the tips of fingers bilaterally (Fig. 2). There were no lesions found when his feet were examined. He was diagnosed with the hand, foot and mouth disease (HFMD) and received symptomatic therapy with NSAID. Skin lesions healed within 14 days with slight scaling (Fig. 3). Hand, foot and mouth disease (HFMD) or vesicular stomatitis exanthema is an acute viral infection produced by enteroviruses: mainly Coxsackievirus A16 (CV-A16) and Enterovirus 71 (EV-A71) [1]. In the recent years, other enteroviruses such as CV-A6 and CV-A10 have been widely associated with both sporadic cases and outbreaks of HFMD worldwide [2–4]. Children younger than 5 years are often affected, because they do not yet have immunity (protection) to those viruses. The main way of transmission of this infection is through nose and throat secretions (such as saliva, sputum, or nasal mucus), and blister fluid [1, 6]. In children, the disease usually presents with vesicles or ulcers in the oral cavity occurring chiefly on the buccal mucosa and tongue, and also blisters in hands, feet and buttocks. This illness is typically mild, and nearly all people recover in 7–10 days without medical treatment. Complications are uncommon [1, 6]. Only 1% of infected adults develop clinical manifestations. In the last decade, there have been several reports about HFMD happening in adults with atypical clinical manifestations. Vesiculobullous lesions are generally localized in the perioral and perinasal areas of the face, but also on the scalp. Palmar purpuric maculae is a typical feature in adult patients and it is the clinical expression of vesicles more deeply located in the epidermis, probably due to the greater thickness of the palmoplantar epidermis. [5, 7–9]. Virological confirmation of virus involved can be obtained either from saliva, throat and nasal secretion and feces [5]. Our patient’s differential diagnoses included herpangina, varicella and erythema multiforme. We considered that typical clinical manifestations and epidemiological history was

Do Spanish Hospital Professionals Educate Their Patients About Advance Directives

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.

Early ventriculoperitoneal shunt infection

cultures were positive for Staphylococcus aureus. The isolates were susceptible to penicillin, co-trimoxazole, oxacillin, erythromycin, levofloxacin and vancomycin; resistant to gentamicin (determined by minimum inhibitory concentration in μg/mL). Empiric treatment was started with 600 mg of linezolid twice daily and 2 g IV every 8 h of meropenem which was changed to cloxacillin 2 g IV q 4 h after antibiogram results. After 15 days with antibiotics and 2 new CSF culture negatives, he underwent a new ventriculoperitoneal shunt without complications. Implantation of the ventriculoperitoneal shunt is the most widely used treatment for hydrocephalus. VP shunt infection is one of the most important and common complications [1]. Shunt infection rates per patient range from 10 to 22 % and around 6.0 % per procedure, with 90 % of infections occurring within 30 days of surgery. These events are mostly attributable to normal skin flora such as coagulase-negative staphylococci, S. aureus and Propionibacterium acnes, which are thought to be introduced at the time of surgery although Gram-negative organisms and Candida species have also been reported [2, 3]. In contrast to native meningitis, shunt-associated infections often presented with nonspecific clinical signs and symptoms (e.g., fever), whereas typical neurological manifestations—such as neck stiffness, headache, and nausea— were present in less than one-half of the episodes. Local signs of infection were present in half of episodes including erythema, local pain, swelling, and/or purulent wound discharge [3–5].

Aplasia pura de células rojas y tiroiditis de Hashimoto: una rara asociación

an adult growth hormone deficient patient after growth hormone treatment. J Rehabil Med. 2009;41:775–7. 5. Lee WH, Michels KM, Bondy CA. Localization of insulin-like growth factor binding protein-2 messenger RNA during postnatal brain development: Correlation with insulin-like growth factors I and II. Neuroscience. 1993;5:251–65. 6. Rudman D, Feller AG, Nagraj HS, Gergans GA, Lalitha PY, Goldberg AF, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990;323:1–6. 7. Evans LM, Davies JS, Anderson RA, Ellis GR, Jackson SK, Lewis MJ, et al. The effect of GH replacement therapy on endothelial function and oxidative stress in adult growth hormone deficiency. Eur J Endocrinol. 2000;142:254–62. 8. Böger RH. Nitric oxide and the mediation of the hemodynamic effects of growth hormone in humans. J Endocrinol Invest. 1999;22:75–81. 9. Ministerio de Sanidad y Consumo. Criterios para la utilización racional de la hormona del crecimiento en adultos. 2004. Disponible en: http://www.msps.es/ profesionales/farmacia/pdf/CriteriosHCAdultos.pdf.

Prurito en la planta y el dorso de los pies en una viajera procedente de Centroamérica

piel, ya que el hombre es un huesped circunstancial y elparasito no puede completar su ciclo vital.Los pacientes afectados suelen contar con el anteceden-te de haber caminado descalzos o haberse sentado o tum-bado directamente sobre el suelo. El periodo de incubacionoscila desde horas hasta varios meses, hasta aparecer lalesion cutanea tipica, serpenteante, pruriginosa y migra-toria conocida como erupcion reptante