J. García Alegría

Comorbilidad de los pacientes ingresados por insuficiencia cardiaca en los servicios de medicina interna

BACKGROUND AND OBJECTIVES Heart Failure (HF) patients present frequently comorbidities. Little is known about the impact of these comorbidities in morbimortality. We analyzed the comorbidities of HF patients admitted in Spanish internal medicine units and its relation with different socio-demographics and clinical variables. PATIENTS AND METHODS We studied prospectively 2127 patients (admitted from 01.10.2000-28.02.2001) with HF in 51 Hospitals of different categories (from local hospitals to university hospitals) in which an internist was available to collaborate in the study. Comorbidities were estimated by the Charlson index. RESULTS Mean age was 77 years (women 57%). 45% of patients have had a previous admission in the last year. 41% had a functional stage NYHA iii/iv. Eyection fraction was preserved in 53% of patients. Comorbidities were identified in 60% of patients (diabetes mellitus, 39%; chronic lung disease 31%). The average Charlson index was 5.4 points (range 2-11 points). Global inhospital mortality was 6.1%. During the admission more patients died in the Group with higher comorbidities (Charlson, >3 points; 8.4%) than in the Group with low Charlson index (1-2, 5.2%; p<0.01). Treatments prescribed were similar in both groups. In a multivariant analysis comorbidities was associated independently with masculine gender, age superior to 75 years, functional status NYHA iii/iv and dysfunctional physical capacity. CONCLUSIONS Comorbidities determined by Charlson index were associated with more frequent admission, longer stay in hospital, higher discapacity and higher mortality. These results enhance the importance of comorbidities in prognosis of heart failure patients admitted in internal medicine units in Spain.

Agranulocitosis por metamizol: un potencial problema en la población británica

Resumen Objetivo Analizar las caracteristicas clinicas y epidemiologicas de este efecto adverso y valorar su incidencia en la poblacion general, especialmente en la britanica. Metodo Analisis descriptivo retrospectivo de todos los pacientes ingresados en el Hospital Costa del Sol (Marbella), con el diagnostico al alta hospitalaria, mediante el Conjunto Minimo Basico de Datos, de agranulocitosis por metamizol, durante el periodo desde enero de 1998 hasta diciembre de 2003. Se definio la neutropenia como grave (neutrofilos inferiores a 500/ml), moderada (500-1.000/ml) y leve (1.000-1.500/ml). Resultados De los 13 pacientes 8 eran extranjeros (61,5%), siendo 5 del Reino Unido. La tasa de eventos fue de 8,33/106 habitantes/ano para la poblacion general censada. La tasa de eventos estimada en la poblacion britanica fue de 20,4 casos/106 habitantes/ano. Conclusion En nuestro medio la agranulocitosis por metamizol es un efecto adverso que se da con mayor frecuencia en los britanicos, por lo que debe evitarse su uso.

Calidad de la asistencia hospitalaria y riesgo de reingreso precoz en la exacerbación aguda de la EPOC

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the diseases that causes more readmissions in our hospitals. The objective of our study was to establish the influence of quality of inpatient care on the risk of early readmission in the acute exacerbation of COPD. Material and methods: Design: case and controls study. Setting: general acute care hospital. Subjects of study: random sample of admissions with acute exacerbation of COPD and discharged alive. Cases: patients who were readmitted within 30 days with a related diagnosis. Controls: patients who were not readmitted and finished alive the mentioned period. Interventions: audit of clinical charts with evaluation of clinical severity and adherence to explicit criteria of quality of inpatient care in OCFA. Bivariate and multivariate logistic regression (LR) analysis. Results: 45 cases and 45 controls were analyzed. LR model detected the risk of readmission within 1 month was explained by the higher severity of patients (Apache III: OR 1,03) and their principal diagnosis (emphysema: OR 6,9 and bronchiectasias: OR 2,2, respect to chronic bronchitis). The less score of quality of care scale was predictive of the risk of readmission in the subgroup of patients who were readmitted within 1 week (OR 0,9). Conclusions: Risk of readmission within 1 month in the acute exacerbation of COPD were explained mainly by the clinical characteristics of patients. Otherwise, readmissions within 1 week were related to quality of care, so it could be a valid indicator of quality of inpatient care.

Endoftalmitis y abscesos cerebrales múltiples en un paciente con endocarditis por Streptococcus agalactiae

: Endogenous endophthalmitis is a rare disease caused by hematogenic germ spread from an internal focus. Infections due to Streptococcus agalactiae are infrequent in adults although new cases had been described recently associated to inmunodepression. We present a patient with endocarditis due to Streptococcus agalactiae, endophthalmitis and multiple brain abscess. We also review the literature.