[Scores to predict the number of hospitalization days in a general ward at a tertiary hospital]. / Score predictor de días de estancia para sala común.

UNLABELLED: Although most usual admissions to hospital are in rooms in general wards, there are not scores to predict the number of hospitalization days in this area. The patients are located based on diagnosis at admission. AIM: to make scores who predict the number of hospitalization days in the general wards. METHODS: We studied all the patients who were admitted to the Italiano Hospital from march of 2004 to may of 2005 in Cordoba city (Argentina). The inclusion criteria were: more than 18 years old patients who were admitted for more than 24 hours due to clinical or surgical conditions in general wards. We evaluated 53 variables including background, toxics, physiologic and demographic data, social reports, nutritional condition, out patients previous consultations at the admission day. Died patients were not included in this score analysis. RESULTS: The number of patients included was 1003. Short hospitalization was considered when the number of the days of the hospitalization was less than 4 days and long hospitalization was more than 5 day in a general ward. We made a score with 11 main variables according to physician clinical perception. The statistical analysis was not significant in each variable studied. When we analyzed the score with 11 of them as a whole, it showed statistical significance. We divided in categories and pointing according to statistic settlements. Minimum pointing: 11; maximum: 33. Showed R2: 0,77 ( p: 0,06) between pointing and the hospitalization days. CONCLUSION: The lower scores were related with a high chance of discharge before 5 days. This score may be a simple and feasible tool for the hospital administration and for the prediction of available beds in a general wards.

[Long duration of hospital stay in a clinical service]. / Internación prolongada en un servicio de clínica médica.

UNLABELLED: In order to identify determining factors and complications in illness, we evaluated patients under long period hospitalization, in a Clinical Service. METHODS: retrospective and descriptive studies. Figures were evaluated by Chi-, Fisher T and Test T, thrue variables. We call long period hospitalization to a staying of 10 days or longer. RESULTS: 322 patients were evaluated. 50 (15,5%) presented (LS) and 272 < 10 days staying. Age average was 63,8 for < 10 days and 66 for (LS). Mostly of diagnosis at admission for < 10 days were respiratory dysfunction (25%) including pneumonia (10%), urinary infection and heart failure, and for LS pneumonia 20%, acute neurological disease 18 %. The 46 % of LS required surgery vs. 20,6% (p < 1,01). The LS needed parenteral nutrition 26 % vs. 12,5% (p < 0,02). The average of maximum amount of drugs/day in staying was: 5,8 for < 10 days and 8,76 for LS (p < 0,01). Hospital complications in LS were 28 % vs. 11% (p < 0,01), mainly nosocomial pneumonia (p < 0,01) and endovascular infections (p < 0,01). Staying in ICU was 54% for LS vs. 19% (p < 0,01), and average of days in intensive care unit (ICU) was 8 in LS vs. 3 (p < 0,01). There wasn't any difference in mortality. CONCLUSION: the admission's diagnosis and the ICU's staying were the main causes of LS, but not so age and co-morbilities studied. The LS patients require more complex and expensive staying. They present more hospital complications.

[Characteristics of patients admitted with enteral nutrition in a service of clinical medicine]. / Caracteristicas de los pacientes internados con alimentacion enteral de un servicio de clínica médica.

BACKGROUND: When a patient is unable to swallow enough calories by mouth and has his digestive tube working normally, the Enteral Nutrition (EN) is prescribed. Our aims was identify the patient who requires EN by sounding at Clinical Medical admission. METHODS: From 11/2001 to 11/ 2002; 331 patients were attended in common rooms. 50 of them (15%) required EN. Retrospective descriptive study was made, evaluating: demographic data, diagnoses, comorbilities, self-validity, staying, nosocomial complications, studies, medicaments, inter-consulting and mortality as well. RESULTS: In 50 patients under EN, 56 % were men, with an age rate of 65 years Standar Error (SE) 2.37 and daily life activity medium rate was 2 (SE) 0.35. Diagnoses at admission: Strocke 22%, acute pneumonia of community 22%, pneumonia by bronchoaspiration 10 %, acute confusional syndrome 10%, etc. Comorbilities: 54% presented 3 or more concurrent diseases, Hypertension 60 %, Dementia 28%, type 2 Diabetes and strocke 26%, iskemic cardiopathy 14%, etc. Admission time rate: 6 days (SE) 2.02, staying at intensive care unit 40%. Nosocomial complications came up in 34%, 76% ACS, 11.7% urinary tract infection, pneumonia and endovascular infection 1 each. 4 labs were required in rate (SE) 1.14, and 3 complementary studies per patient (SE) of 0.24. In ambulatory treatment they used 3 drugs as an average (SE) 0.37. The highest prescription day approached 7 as average (SE) of 0.61. At discharge they left with an average of 4 (SE) 0.39. In every case kinesiotherapy and phonoaudiology were used as well. Ther was interconsulting regarding infectology in 24%, general surgery 16%. Mortality 22%. CONCLUSION: EN is usual in clinical admission. It regards an elderly patient with lacking self-validity, who over 50% of cases presents more than three comorbilities (mostly hypertension). Facts of admission usually registered: neurological pathologies and infections. Admission length was the same as general settlers. Almost half of them needed intensive care assistance. Nosocomial complications are usually found. They are patients who require many drugs at home, while admitted and discharge time as well. In every one kinesiotherapy and phonoaudiology were applied. Mortality raised high. Unable chance to use commercial diets was not a trouble to feed them.

Internación prolongada en un servicio de clínica médica. / [Long duration of hospital stay in a clinical service]

In order to identify determining factors and complications in illness, we evaluated patients under long period hospitalization, in a Clinical Service. METHODS: retrospective and descriptive studies. Figures were evaluated by Chi-, Fisher T and Test T, thrue variables. We call long period hospitalization to a staying of 10 days or longer. RESULTS: 322 patients were evaluated. 50 (15,5

) presented (LS) and 272 < 10 days staying. Age average was 63,8 for < 10 days and 66 for (LS). Mostly of diagnosis at admission for < 10 days were respiratory dysfunction (25

) including pneumonia (10

), urinary infection and heart failure, and for LS pneumonia 20

, acute neurological disease 18

. The 46

of LS required surgery vs. 20,6

(p < 1,01). The LS needed parenteral nutrition 26

vs. 12,5

(p < 0,02). The average of maximum amount of drugs/day in staying was: 5,8 for < 10 days and 8,76 for LS (p < 0,01). Hospital complications in LS were 28

vs. 11

(p < 0,01), mainly nosocomial pneumonia (p < 0,01) and endovascular infections (p < 0,01). Staying in ICU was 54

for LS vs. 19

(p < 0,01), and average of days in intensive care unit (ICU) was 8 in LS vs. 3 (p < 0,01). There wasnt any difference in mortality. CONCLUSION: the admissions diagnosis and the ICUs staying were the main causes of LS, but not so age and co-morbilities studied. The LS patients require more complex and expensive staying. They present more hospital complications.

[Castleman disease]. / Enfermedad de Castleman.

A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90%, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.

Enfermedad de Castleman. / [Castleman disease]

A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90

, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.