Características de la hospitalización reumatológica en un hospital de nivel terciario / Features of patients with rheumatic diseases admitted to a tertiary care hospital

Background: The diagnostic profile of patients with rheumatic diseases admitted to a general hospital is variable. Aim: To report the epidemiological profile of patients with rheumatic diseases admitted to a tertiary care hospital. Material and methods: All admissions to a Medicine ward of a general hospital and seen by the Rheumatology team were prospectively registered during one year in 1999. Patients were classified as primarily admitted for a rheumatic disease or admitted for other cause that required a consultation with the Rheumatology team. Results: One hundred forty five admissions due to rheumatic diseases were registered. Of these, 82 were due to primary rheumatic diseases. Systemic lupus erythematosus, rheumatoid arthritis and vasculitis were the main diagnoses and the mean hospital stay was 18.5 days. Sixty three patients required a consultation with the Rheumatology team specially due to osteoarthritis and crystal induced diseases. Conclusions: Admissions due to rheumatic diseases are prolonged, correspond to 0.46 per cent of all admissions and the main responsible disease is systemic lupus erythematosus

Infección por nocardia asteroides en un paciente con lupus eritematoso sistémico / Nocardia asteroides infection in a patient with systemic lupus erythematosus

Nocardia asteroides infection are unusually observed in sistemic Lupus erithematous (SLE) patients. They are generally associated to steroidal and immunosuppressive therapy. We report a 24 years old female with SLE diagnosed in 1994 who developed a severe preeclampsia in her first pregnancy requiring emergency caesarean section. Post partum acute renal failure and type IV lupus nephropathy were treated with hemodialysis, metilprednisolone, cyclophosphamide and prednisone. Three months later, while she was receving the fourth cyclophosphamide dose, she presented with a pleuro pneumonia and occipital abscess, both caused by Nocardia asteroides. She was treated with cotrimoxazole + cefixime and pleural decortication was required. Five months later, she developed Meningitis caused by Nocardia asteroides and hydrocephalus. She was treated with ceftriaxone, vancomycin, cotrimoxazole and ventricular shunting procedure. Two months later, a retroperitoneal abscess was diagosed and surgically drained but the patient died, due to a methicillin-resistant Staphylococcus aureus septicemia

Avances en el diagnóstico de las vasculitis sistémicas / Recent progress in the diagnosis of systemic vasculitis

The clinical picture of primary systemic vasculitis, that cause inflammation and necrosis of vessel walls, depend on the type, size and location of involved vessels. Frequently, their clinical presentation does not reflect the specific type of vasculitis and its prognosis. Moreover, the correct diagnosis, early and adequate treatment have an important prognostic value. Recently, new diagnostic methods for systemic vasculitis have been devised. This article critically reviews and provides information for the rational use of these new imaging techniques and laboratory procedures for the diagnosis and follow up of systemic vasculitis

Educación en pacientes con artritis reumatoidea: evaluación de una encuesta de intereses / Education of patients with rheumatoid arthritis: assessment of a survey of interests

Background: The congruence of interests between health care providers and clients is essential if subjects with chronic diseases will be educated. Aim: To assess, in patients with rheumatoid arthritis, those fields in which they would like to receive education. Patients and methods: Eighty eight patients with rheumatoid arthritis were surveyed about the topics in whicb they would like to be educated. The inquiry included medical aspects, handicap overcoming, social issues and labor aspects. Results: Eighty two percent of Patients were interested in medical aspects, 77 percent in social issues and 71 percent in handicap overcoming. Eighty three percent of Patients with greater handicaps preferred handicap overcoming, 75 percent social aspects and 74 percent medical aspects. Younger patients had a greater interest in labor aspects, those with a recently diagnosed disease were interested in legal rights and those with a prolonged disease wanted information about self help groups. Conclusions: The greater educational interests of patients with rheumatoid arthritis were on medical aspects. However, those impaired by the disease were interested in handicap overcoming. Age and duration of the disease also influenced the educational interests of patients. Thus, education in these patients must be individualized

Efecto de un manual educativo sobre conocimientos y actitudes en pacientes reumáticos y personal de salud / Impact of an educational handbook on knowledge and attitudes of rheumatic patients and health workers

To assess the impact of the educational manual Aches and Pain, on knowledge and attitudes of patients with chronic rheumatism and paramedics, using an instrument with 40 aseverations extracted from the manual, 77 patients and 42 paramedics were studied. The assessment instrument was responded before and after reading chapters of the manual, selected by the authors. Knowledge was quantified according to the number of correct answers. Adaptation to disease, optimism and self help capacity were the evalauted attitudes, using a five point scale. The study was completed by 48 patients and 42 paramedics. Knowledge improved from 19,9ñ5,3 to 25,6ñ6,15 correct answers in the former and from 23,6ñ4,9 to 30,3ñ5,5 in the latter (p<0,001), In patients there were improvements in the degree of adaptation to disease from 3,3ñ0,9 to 4,0ñ0,8 and in selfhelp capacity from 4,0ñ0,8 to 4,3ñ0,8; optimism did not improve significantly. In conclusion, the eductinal manual had an impact on knowledge and improved rheumatic patient's attitudes towards the disease