Manuel Quintana Díaz

Eficacia de una intervención para dejar de fumar en pacientes con infarto de miocardio

Fundamento El objetivo de este ensayo clinicoaleatorizado es evaluar la eficacia de una intervencionestructurada basada en el consejo medicoen pacientes con infarto agudo de miocardioingresados en una unidad de cuidados intensivos (UCI), frente al consejo antitabaco habitual. Pacientes y metodos Se estudiaron 90 pacientesque fueron asignados de forma aleatoria para recibirla intervencion especifica (grupo intervencion)o la intervencion habitual (grupo control). El consejomedico se hizo durante el ingreso en UCI y ala segunda, tercera y cuarta semanas. Un ano mastarde se determinaba el estado de no fumador. Resultados Al ano, 26 sujetos del grupo intervencion(60,5%) y 31 sujetos del grupo control(66,0%) dejaron de fumar (riesgo relativo [RR]0,88; intervalo de confianza del 95% [IC 95%RR] 0,57-1,37). Conclusiones El porcentaje de sujetos que dejande fumar despues de un infarto de miocardioes alto. La intervencion basada en el consejomedico parece no ser efectiva para reducir elnumero de fumadores al cabo de un ano.

Resultados de una encuesta nacional sobre hábito transfusional en unidades de cuidados intensivos

Introduccion Los hemoderivados son productos clinicos de uso habitual que presentan unas caracteristicas de escasez, relevancia clinica y de efectos secundarios concomitantes que obligan a conocer y evaluar su utilizacion con rigurosidad. Objetivo Analizar actitudes, conocimientos y conductas sobre la politica transfusional de las diferentes unidades de cuidados intensivos (UCI) espanolas. Diseno Encuesta mediante correo (electronico y tradicional) en las unidades de cuidados intensivos. Periodo Planificacion durante 2004 y realizacion durante todo 2005. Ambito UCI espanolas. Pacientes y metodo Cuestionario de 27 preguntas. Resultados La mayoria son UCI de tamano medio (10-20 camas), con actividad predominantemente medica. El adjunto, solo o con el residente, suele decidir la transfusion segun su experiencia, aunque con tendencia a seguir las recomendaciones cientificas. No suele haber comites transfusionales. Cuando se transfunden concentrados de hematies, suelen ser entre 2 y 4 unidades. La cifra de hemoglobina es orientativa, aunque la decision es clara si es Conclusiones Debemos reflexionar sobre la transfusion y evitar la sobreutilizacion. Para ello se necesitan protocolos educacionales y conferencias de consensos que establezcan recomendaciones sobre el uso de los hemoderivados y sus alternativas farmacologicas.

Motivos de consulta de pacientes con enfermedades autoinmunes sistémicas en el servicio de urgencias de un hospital terciario

BACKGROUND The causes of acute decompensations of patients with systemic autoimmune diseases are not well known. AIM To describe the causes for consultation in an emergency room of patients with systemic autoimmune diseases. MATERIAL AND METHODS Review of medical records of patients with systemic autoimmune diseases, aged over 14 years, consulting in an emergency room of a general hospital during three months. RESULTS In the study period, 166 patients with systemic autoimmune diseases consulted in the emergency room, of a total of 18,153 consultations (0.9%). Patients with rheumatoid arthritis were those that consulted with higher frequency (37%) followed by patients with systemic lupus erythematosus (21%). The most common causes for consultation were cardiovascular diseases in 25%, followed by digestive disorders in 15%. The most common diagnosis was chest pain with suspected ischemic heart disease in 36%. No differences in cardiovascular risk factors were observed between those patients consulting for cardiovascular diseases and those consulting for other causes. CONCLUSIONS The most common cause of consultation in the emergency room of patients with systemic autoimmune diseases is cardiovascular.Background: The causes of acute decompensations of patients with systemic autoimmune diseases are not well known. Aim: To describe the causes for consultation in an emergency room of patients with systemic autoimmune diseases. Material and methods: Review of medical records of patients with systemic autoimmune diseases, aged over 14 years, consulting in an emergency room of a general hospital during three months. Results: In the study period, 166 patients with systemic autoimmune diseases consulted in the emergency room, of a total of 18153 consultations (0.9%). Patients with rheumatoid arthritis were those that consulted with higher frequency (37%) followed by patients with systemic lupus erythematosus (21%). The most common causes for consultation were cardiovascular diseases in 25%, followed by digestive disorders in 15%. The most common diagnosis was chest pain with suspected ischemic heart disease in 36%. No differences in cardiovascular risk factors were observed between those patients consulting for cardiovascular diseases and those consulting for other causes. Conclusions: The most common cause of consultation in the emergency room of patients with systemic autoimmune diseases is cardiovascular.BACKGROUND The causes of acute decompensations of patients with systemic autoimmune diseases are not well known. AIM To describe the causes for consultation in an emergency room of patients with systemic autoimmune diseases. MATERIAL AND METHODS Review of medical records of patients with systemic autoimmune diseases, aged over 14 years, consulting in an emergency room of a general hospital during three months. RESULTS In the study period, 166 patients with systemic autoimmune diseases consulted in the emergency room, of a total of 18,153 consultations (0.9%). Patients with rheumatoid arthritis were those that consulted with higher frequency (37%) followed by patients with systemic lupus erythematosus (21%). The most common causes for consultation were cardiovascular diseases in 25%, followed by digestive disorders in 15%. The most common diagnosis was chest pain with suspected ischemic heart disease in 36%. No differences in cardiovascular risk factors were observed between those patients consulting for cardiovascular diseases and those consulting for other causes. CONCLUSIONS The most common cause of consultation in the emergency room of patients with systemic autoimmune diseases is cardiovascular.

Insuficiencia ventricular izquierda precoz en pacientes con síndrome coronario agudo sin elevación persistente del segmento ST: primera descripción y evaluación de los factores asociados

BACKGROUND AND OBJECTIVE The frequency of left ventricular failure (LVF) in the early stages of non-ST-segment elevation acute coronary syndrome (NSTE ACS) has not been described so far. The objective of this study is to describe for the first time the frequency of LVF in the early course of NSTE ACS and to assess its association with other interventions. PATIENTS AND METHOD Observational prospective cohort multicenter study in intensive and coronary care units (ICCU). Patients with NSTE ACS admitted within 24h after onset were included. Main outcome was the occurrence of LVF. We evaluated the association between LVF and clinical and therapeutic variables. RESULTS LVF occurred in 15.6% of patients. Coronary angiography (CA) during admission to the ICCU was a protective variable against the main outcome, performed before 72h (odds ratio [OR] 0.47; 95% confidence interval [95% CI] 0.25-0.89; P=.022) and later (OR 0,39; 95% CI 0,15-0,98; P=.044). The administration of beta-blockers was a protective variable against the occurrence of LVF (OR 0,54; 95% CI 0,32-0,87; P=.013). Patients receiving acetylsalicylic acid before admission to the ICCU had a higher risk of developing LVF (OR 1.74; 95% CI 1.06-2.86; P=.028). Age was also a factor of risk for LVF (OR 1.02; 95% CI 1.00-1.05; P=.032). CONCLUSIONS CA and beta-blockers can decrease the occurrence of LVF. The association between previous administration of acetylsalicylic acid and age with the occurrence of LVF may reflect long-standing cardiovascular disease.