ABSTRACT
La fiebre es una anormalidad común en los pacientes hospitalizados en la unidad de cuidados intensivos. Encontrar la etiología del cuadro significa una alta demanda de recursos materiales y humanos que podrían afectar el pronóstico del paciente. Los objetivos de este trabajo fueron identificar las causas actuales de fiebre desarrollada en pacientes durante su hospitalización en la Unidad de Cuidados Intensivos Generales (UCIGEN) y describirlas según su prevalencia; categorizarlas en etiología infecciosa y no infecciosa; determinar el pronóstico según su etiología y buscar la existencia de elementos clínicos y de laboratorio que orienten a una causa infecciosa o no infecciosa. Se realizó un estudio de cohorte retrospectiva que consideró a todos los pacientes hospitalizados por7 o más días en la UCIGEN del Hospital Naval Almirante Nef y que egresaron de ella entre julio del año 2007 y julio del año 2012. De un total de 386 pacientes, 82 presentaron fiebre (21,24 por ciento) y en 10 de ellos (12,20 por ciento) no se logró determinar la causa. En los 72 pacientes (87,80 por ciento) que tuvieron una causa conocida, 67 casos fueron de etiología infecciosa y 5 de etiología no infecciosa. La principal causa de fiebre fue la neumonía asociada a ventilación mecánica (31,76 por ciento), seguida de la infección con uno o más microorganismos diferentes en más de un foco infeccioso (12,20 por ciento). No hubo relación estadísticamente significativa entre la etiología de la fiebre y elementos clínicos ni de laboratorio, como tampoco entre el pronóstico y la etiología (OR =0,684; IC 95 por ciento = 0,073 - 8.816). En conclusión, la fiebre desarrollada en los pacientes de la UCIGEN es predominantemente de origen infeccioso cuya causa más frecuente es la neumonía asociada a ventilación mecánica. Se recomienda orientar la búsqueda hacia una etiología infecciosa,...
Fever is a common abnormality in the ICU patients. Finding the fever etiology means a high demand of material and human resources that could affect the patient prognosis. The objectives of this investigation were to identify the actual causes of fever developed in patients during their hospitalization in the ICU and describe them according to their prevalence; categorize them according in infectious and noninfectious etiology; determinate their prognosis according to their etiology and find the existence of clinical and laboratory elements to guide a cause infectious or noninfectious. A retrospective cohort study was realized that considered 386 patients hospitalized for 7 or more days at the Hospital Naval Almirante Nef ICU and were discharged from it in July of 2007 and July of 2012. From a total of 386 patients, 82 did fever (21.24 percent) and in 10 of them (12.20 percent) were not able to determine the cause, of the 72 patients (87.80 percent) who had a known cause, 67 cases were due to infection and only 5 cases due to a non-infectious cause. Of all patients who developed fever, the leading cause was mechanical ventilation-associated pneumonia (31.76 percent), followed by infection with one or more isolated microrganism (12.20 percent). There was no statistically significant relationship between the etiology of fever and clinical or laboratory items, nor there was between the prognosis and etiology (OR = 0.684, 95 percent CI = 0.073-8.816). In conclusion the currently fever developed in ICU patients is predominantly due to an infectious cause and is most often caused by mechanical ventilation-associated pneumonia. It is recommended to guide the search for an infectious etiology,...
Subject(s)
Humans , Male , Female , Middle Aged , Fever/epidemiology , Fever/etiology , Intensive Care Units/statistics & numerical data , Communicable Diseases/epidemiology , Hospitalization , Longitudinal Studies , Pneumonia, Ventilator-Associated/epidemiology , Observational StudyABSTRACT
We report a 70-year-old woman, who had recently consumed shellfish, that was admitted to the intensive care unit with septic shock and died 19 hours later due to a multi-organic failure. Microbiological, serological and molecular assays confirmed a hemolytic tdh+ Vibrio cholerae non-01, non 0139 as the etiologic agent (Rev Méd Chile 2009; 137: 1193-6).
Subject(s)
Aged , Female , Humans , Food Microbiology , Sepsis/microbiology , Shellfish/microbiology , Vibrio cholerae non-O1/pathogenicity , Fatal Outcome , Hemolysis/physiology , Sequence Analysis, RNA , Vibrio cholerae non-O1/geneticsABSTRACT
Antecedentes: En Chile han ocurrido cambios biodemográficos importantes en las últimas décadas aumentando las expectativas de vida al nacer sobre los 76 años. Ello ha provocado un cambio en la morbilidad. Objetivo: Conocer la prevalencia de enfermedades crónicas no transmisibles (ECNT) en los enfermos fallecidos en un Servicio de Medicina (SDM). Material y método: En 520 pacientes consecutivos se registró la prevalencia en ECNT, según criterios diagnósticos estrictos. Se correlacionaron utilizando regresión logística a los diagnósticos entre sí, con la edad y género. Resultados: Un 54 por ciento eran hombres y la mediana de edad 78 años. Setenta por ciento tenía hipertensión arterial (HTA), 37 por ciento deterioro cognitivo (DOC), 34,2 por ciento cáncer, 29,6 por ciento diabetes mellitus (DM), 20.6 por ciento secuelas de accidente cerebrovascular, 19.2 por ciento enfermedad coronaria, 16.5 por ciento fibrilación auricular, 15.6 por ciento insuficiencia cardíaca y 15.6 por ciento daño hepático crónico. Uno de cada 3 estaba postrado crónicamente y 1 de cada 4 estaba desnutrido al ingresar al hospital. En el análisis multivariado la HTA se asoció a DM, fibrilación auricular e insuficiencia renal crónica (IRC). El DOC se asoció sólo a la enfermedad de Parkinson. No hubo ninguna patología que se asociara significativamente al cáncer. La DM se asoció a la cardiopatía coronaria, HTA e IRC. Las secuelas de un accidente cerebrovascular se asociaron a fibrilación auricula e HTA. El hipotiroidismo se asoció a cardiopatía coronaria y fibrilación auricular. Conclusiones: La mayoría de los fallecidos en un SDM son ancianos mayores de 70 años (75 por ciento) y portadores de múltiples ECNT. Una proporción elevada tienen DOC, desnutrición, están postrados crónicamente y tienen escaras de decúbito. Las enfermedades neurológicas están presentes en el 50.2 por ciento y el cáncer o enfermedades cardiovasculares en un tercio de los fallecidos.
Subject(s)
Male , Adolescent , Adult , Humans , Female , Middle Aged , Chronic Disease/mortality , Chile , Cognition Disorders , Hospital Statistics , Hypertension/epidemiology , Logistic Models , Morbidity , Neoplasms/epidemiology , PrevalenceABSTRACT
Background: The diagnosis of inflammatory bowel disease is supported by clinical findings and complementary tests. The presence of specific serological markers could be helpful in the characterization of this condition. Aim: To assess the prevalence of ANCA and ASCA in a group of patients with ulcerative colitis (UC) and its association with clinical features. Material and Methods: Sixty four patients with UC in remission (age range 16-72 years, 33 males) were studied. In a venous blood sample ANCA were measured by indirect immunofluorescence and ASCA by enzyme immune assays for IgG and IgA. Results: Forty four percent of patients were positive for ANCA, 9 percent for ASCA and 6 percent for both markers. There was a significant correlation between the presence of ANCA and duration of the UC (<5 years 50 percent, 5-10 years 42.9 percent, 15 years 30 percent) and the number of crises (one crises 31 percent, 2-5 crises 51.9 percent and >5 crises 87.5). The proportion of colectomized patients with positive ANCA was higher (57.1 percent). Conclusions: The prevalence of ANCA in the studied population is similar to the published data. The presence of ANCA was significantly higher in UC patients with shorter evolution, higher number of crises and in those with a history of colectomy. There was a low prevalence of ASCA positive patients.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Antibodies, Antineutrophil Cytoplasmic/blood , Colitis, Ulcerative/immunology , Saccharomyces cerevisiae/immunology , Age Factors , Biomarkers/blood , Colectomy , Colitis, Ulcerative/blood , Colitis, Ulcerative/surgery , Diagnosis, Differential , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , Inflammatory Bowel Diseases/diagnosisABSTRACT
Abstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). Methods: A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P <0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P <0.001). There was no difference between the two treatment groups in overall mortality. Conclusions: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels.
ABSTRACT
Background: When patients are admitted to an internal medicine ward, they and their relatives believe that they will leave the internal medicine service in a better health condition or, if they die, their cause of death will be the same that motivated the hospital admission. Sometimes, patients die due to a different disease than the cause of admission or due to complications of diagnostic or therapeutic procedures. Aim: To assess the proportion of deaths that occurred in internal medicine wards for causes that differ from the cause for admission and the proportion of deaths related to complications of diagnostic or therapeutic procedures. Patients and methods: Three hundred and three consecutive patients were studied during 28 months. Their cause of death was classified in four groups: A. If it was the same illness of admission; B. A frecuent or expected complication of the illness that motivated the admission; C. A complication of one of their chronic diseases and not the one of admission; D. If it was not related to an already present chronic illness or the cause for admission. Results: Sixty nine percent of deaths corresponded to group A, 7.9 percent to group B, 11.2 percent to group C and 11.9 percent to group D. Diagnostic or therapeutic procedures were the cause of death in 0.7 and 3.6 percent of cases respectively. Conclusions: Twenty three percent of patients died due to causes that differ from the cause of admission. A low percentage of deaths were related to procedures and most of them were due to complications of therapeutic measures (Rev Méd Chile 2004; 132: 707-17).
Subject(s)
Humans , Male , Adult , Female , Aged , Cause of Death , Internal Medicine/statistics & numerical data , Hospital Mortality , Patient Admission/statistics & numerical data , Chile/epidemiology , PrevalenceABSTRACT
Backgroum: lately, autopsies are performed less frequently in hospitals, despite their importance as a diagnostic tool. Aim: to study the concordance between clinical diagnosis and postmortem study in patients that died in a teaching hospital. Material and methods: autopsy findings in 57 patients (aged 16 to 85 years old, 28 female) that died at a University hospital were analyzed. Clinical diagnoses were compared with those of the postmortem examination and the degree of concordance between both diagnoses was calculated. Results: seven major omissions (12.3 percent), whose knowledge could have changed the clinical course of patients, were detected. These omissions occurred in patients with complex diseases or due to limitations of diagnostic procedures. Also, seven omissions, found in severely ill patients, whose knowledge would not change the patient`s evolution, were also detected. Conclusions: autopsy still is a valuable tool to assess the quality of care for patients that die during their hospitalization