[Control of the systolic blood pressure and related factors in patients with high cardiovascular risk]. / Control de la tensión arterial sistólica y factores relacionados en pacientes de alto riesgo vascular.

OBJECTIVE: To know in a good therapeutic compliance population with high cardiovascular risk (HCR), the systolic blood pressure (SBP) control-rate and the factors that could influence. MATERIAL AND METHOD: A cross-sectional observational study was carried out in a HCR hypertensive population in Cáceres (Spain). A survey of different laboratory tests, SBP in first and last visits. RESULTS: Among 388 HCR hypertensive patients, 199 (51.4%) patients with antihypertensive treatment adherence was selected. The average age was of 63 +/- 11 years, 109 (54.1%) males, 61 (30.7%) diabetes mellitus (DM) ones, the 10 years global cardiovascular risk was 22.25 +/- 8.9%, average follow-up was 16.5 +/- 8 months, means SBP was 158 +/- 22 mm Hg. 59.5% with combined treatment, generally diurets with another antihypertensive one. SBP less 140 mm Hg was observe in 23.9% and, only 13.5% less than 130 mm Hg in DM patients. SBP control was more common in less than five years hypertension diagnosis (with respect to those of more time evolution (33.8% vs 15.7%: p < 0.01). as well as, in those with beat pressure (BP) less of 60 mmHg (73.3% versus 26.7%; p < 0.0005). In multivariable analysis also influences negatively in the SBP control: upper 5 years hypertension diagnosis, OR 1.92 (1.08-3.4; p < 0.05) and, a greater BP of 60 mmHg, OR 30.3 (10.6-87: p < 0.0001). CONCLUSIONS: SBP control is difficult to obtain in a population of HCR and good therapeutic compliance, but more still in DM patients. A time of more 5 years evolution of the hypertension and, BP upper of 60 mm HG, have a negative influences in the SBP control.

Control de la tensión arterial sistólica y factores relacionados en pacientes de alto riesgo vascular / Control of the systolic blood pressure and related factors in patients with high cardiovascular risk

Objetivos: Estudiar el grado de control de la tensión arterial sistólica (TAS) y, los factores que pudieran influir en él, en una población de alto riesgo cardiovascular (RCV) con buen cumplimiento terapéutico. Material y método: Estudio observacional realizado en una población hipertensa con RCV elevado en Cáceres. Se recogieron distintas variables biológicas, así como la medición de TA en su primera y última visita. Resultados: De 388 pacientes hipertensos con RCV global elevado se seleccionaron 199 (51,3%) por su buen cumplimiento del tratamiento antihipertensivo. La edad media fue de 63 ± 11 años, 109 (54,1%) varones, 61 (30,7%) diabéticos, el RCV global a 10 años fue del 22,25 ± 9,8%, seguimiento medio 16,5 ± 8 meses, la TAS media fue,158 ± 22 mmHg. El 59,5% realizó tratamiento combinado, generalmente diuréticos con otro antihipertensivo. El 23,9% de los hipertensos presentó cifras de TAS inferiores a 140 mmHg y, el 13,5% de los diabéticos inferiores a 130 mmHg. El control de la TAS fue más probable en los hipertensos con menos de 5 años de conocimiento de su HTA, respecto a los de más evolución (33,8 vs. 15,7%, p 60 mmHg 30,3 (10,6-87: p < 0,0001), influyeron negativamente en el control de la TA. Conclusiones: El control de la TAS en una población de alto RCV con buen cumplimiento terapéutico es difícil de conseguir, más aún en los pacientes diabéticos. El tiempo de evolución de la hipertensión superior a 5 años y, una PP mayor de 60 mmHg, influyen negativamente en el control de la HTA

Objetive: To know in a good therapeutic compliance population with high cardiovascular risk (HCR), the systolic blood pressure (SBP) control-rate and the factors that could influence. Material and method: A cross-sectional observacional study was carried out in a HCR hypertensive population in Cáceres (Spain). A survey of different laboratory tests, SBP in first and last visits. Results: Among 388 HCR hypertensive patients, 199 (51.4%) patients with antihypertensive treatment adherence was selected. The average age was of 63 ± 11 years, 109 (54.1%) males, 61 (30.7%) diabetes mellitus (DM) ones, the 10 years global cardiovascular risk was 22.25 ± 8.9%, average follow-up was 16.5 ± 8 months, means SBP was 158 ± 22 mm Hg. 59.5% with combined treatment, generally diurets with another antihypertensive one. SBP less 140 mm Hg was observe in 23.9% and, only 13.5% less than 130 mm Hg in DM patients. SBP control was more common in less than five years hypertension diagnosis ( with respect to those of more time evolution (33.8% vs 15.7%: p < 0.01). as well as, in those with beat pressure (BP) less of 60 mmHg (73.3% versus 26.7%; p < 0.0005).In multivariable analysis also influences negatively in the SBP control: upper 5 years hypertension diagnosis, OR 1.92 (1.08-3.4; p < 0.05) and, a greater BP of 60 mmHg, OR 30.3 (10.6-87: p < 0.0001). Conclusions: SBP control is difficult to obtain in a population of HCR and good therapeutic compliance, but more still in DM patients. A time of more 5 years evolution of the hypertension and, BP upper of 60 mm HG, have a negative influences in the SBP control

Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres (réplica) / Use and effectivity of influenza vaccination for the prevention of hospital admissions of high risk patients with cardiopulmonary decompensation

No disponible

[Herpes simplex encephalitis in Cáceres. An analysis of the last five years]. / Encefalitis herpética en Cáceres. Análisis de los últimos cinco años.

INTRODUCTION: Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Cáceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. CASE REPORTS: We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. CONCLUSIONS: The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings.

Encefalitis herpética en Cáceres. Análisis de los últimos cinco años / Herpes simplex encephalitis in cáceres. an analysis of the last five years

Introducción. La encefalitis herpética (EH) es una enfermedad rara, aunque la más frecuente de las infecciones víricas humanas graves del sistema nervioso central. La epidemiología y las características clínicas en nuestra zona son actualmente poco conocidas. Se describen retrospectivamente las características clínicas, diagnósticas y evolutivas de los enfermos de EH diagnosticados en el Hospital General de Cáceres, confirmados por el estudio de la reacción en cadena de la polimerasa (PCR) para el ADN del virus del herpes simple en los últimos 5 años. Casos clínicos. Encontramos cuatro pacientes diagnosticados de EH en los últimos 5 años (3,3 casos/millón de habitantes/año; IC al 95%: 2,42-4,18), dos varones y dos mujeres, con un intervalo de edad entre 58 y 75 años. Todos los enfermos presentaron fiebre y tres de ellos, focalidad neurológica. El estudio de tomografía axial computarizada craneal en el momento de su ingreso se interpretó como normal en todos, mientras que la resonancia magnética nuclear craneal, que se realizó en dos pacientes, mostró lesiones compatibles con EH en ambos. En dos enfermos se practicó un estudio de electroencefalografía, que demostró focalidad en un paciente y afectación generalizada grave en otro. El análisis del líquido cefalorraquídeo (LCR) puso de manifiesto meningitis linfocitaria en los cuatro casos, aunque en uno de ellos el estudio fue normal cuando ingresó. En dos de los pacientes, la sospecha de meningoencefalitis vírica se produjo desde el momento del ingreso, por lo que se instauró precozmente un tratamiento con aciclovir IV, con evolución clínica favorable en ambos, aunque con ligeras secuelas neurológicas en uno de ellos. Los otros dos casos, que fallecieron, presentaban una patología grave de base y diagnósticos clínicos alternativos razonables en el momento del ingreso (neumonía extensa y delirium tremens uno de ellos y encefalopatía hipercápnica en paciente con enfermedad pulmonar obstructiva crónica grave el otro), y se retrasó la sospecha clínica de EH y el inicio del tratamiento. Conclusiones. La incidencia de EH en nuestro medio se encuentra en el intervalo alto de la descrita en la literatura. El análisis de PCR para el virus herpes simple en el LCR parece haber desplazado como técnica diagnóstica a la biopsia cerebral. La patología crónica grave subyacente dificulta su diagnóstico y ensombrece el pronóstico. Convendría realizar un estudio epidemiológico multicéntrico para confirmar estos hallazgos

Introduction. Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Cáceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. Case reports. We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. Conclusions. The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings

[Eosinophilic gastroenteritis: two cases report]. / Gastroenteritis eosinofílica: a propósito de dos casos.

Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic infiltration or the different layers of the intestinal wall. Clinical symptoms depend of the site of eosinophilic infiltration and the layers involved. Usually characterized by peripheral eosinophilia. Definitive diagnosis is based on histopathological findings. We report two cases with excellent response to steroid therapy.

Polineuropatía subaguda como forma de presentación de sarcoidosis / Subacute polyneuropathy as presentation of sarcoidosis

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Gastroenteritis eosinofílica: a propósito de dos casos / Eosinophilic gastroenteritis: two cases report

La gastroenteritis eosinofílica es una enfermedad poco frecuente, caracterizada por la presencia de un infiltrado eosinófilo que puede afectar a las distintas capas de la pared intestinal. Las manifestaciones clínicas son variables y los síntomas dependen del grado de infiltración y del número de capas afectadas. Se caracteriza por presentar, en la mayoría de los casos, eosinofília periférica. Su diagnóstico definitivo es anatomopatologico. Aportamos dos casos, ambos con excelente respuesta al tratamiento esteroideo (AU)

Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres / Utilization and effectiveness of the flu vaccination in the prevention of the hospitalization induced by cardiorespiratory decompensation in high-risk patients in Cáceres

Introducción. A pesar de las recomendaciones de vacunar anualmente contra la gripe a todos los ancianos y personas con diversas enfermedades crónicas, éstas no se cumplen. Hemos analizado el grado de utilización de la vacunación antigripal en la temporada 2000/2001 en pacientes mayores de 65 años con patologías crónicas de alto riesgo y su eficacia en cuanto a evitar ingresos hospitalarios por descompensación cardiorrespiratoria, reducir el número de consultas a su médico de Atención Primaria y días e ingreso hospitalario en un estudio casos/control en el servicio de Medicina Interna del Hospital de Cáceres. Pacientes y métodos. Se estudiaron 227 pacientes mayores de 65 años con enfermedad cardiorrespiratoria crónica, diabetes, insuficiencia renal crónica, hepatopatía, neumonía previa u otras causas de inmunosupresión. De ellos, 116 ingresaron por descompensación cardíaca o respiratoria (casos) y 99 pacientes seguidos en consultas externas que no ingresaron este año (controles), con características clínicas similares. A todos se les realizó un cuestionario que incluía características demográficas y de su enfermedad de base, se agruparon según el número de enfermedades subyacentes (una, dos o más), si había recibido la vacunación antigripal correcta, número de consultas a su médico de familia ese año por infecciones respiratorias, ingresos el año anterior y, en caso de ingreso, días que permaneció ingresado. Resultados. La edad media fue de 71 años, el 63 por ciento había ingresado el año anterior. El porcentaje de vacunados fue del 60 por ciento, la vacunación fue más empleada en los mayores de 75 años (p < 0,001), con enfermedad pulmonar obstructiva crónica (EPOC) (p < 0,005) e insuficiencia cardíaca (p < 0,01) y enfermos con dos o más factores de riesgo (p < 0,001). No encontramos diferencias entre casos y controles en cuanto a la edad, número de enfermos con insuficiencia cardíaca congestiva (ICC), diabetes mellitus (DM) ni padecer dos o más factores de riesgo, pero los que ingresaron padecían más de EPOC (OR: 3,6; IC: 2,01-6,45) y tenían más antecedentes de neumonía (OR: 5,24; IC: 2,4-11,14). Los factores que más influyeron en la posibilidad de ingreso fueron: EPOC (OR: 3,67; IC: 1,90-7,13) y antecedente de neumonía previa (OR: 3,88; IC: 1,69-8,95). La estimación de ingresos evitados por la vacunación fue del 59 por ciento (OR: 0,41; IC: 0,22-0,79), aunque no disminuyó el número de consultas a su médico ni los días de ingreso. Conclusiones. La vacunación antigripal parece infrautilizada en pacientes mayores de 65 años con pluripatología en el medio hospitalario. La vacunación parece ser eficaz en cuanto a que disminuye el número de ingresos por descompensación cardiorrespiratoria, incluso en estaciones no epidémicas. Deberíamos insistir en el empleo de la vacunación antigripal en estos pacientes de alto riesgo (AU)

[Utilization and effectiveness of the flu vaccination in the prevention of the hospitalization induced by cardiorespiratory decompensation in high-risk patients in Cáceres]. / Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres.

INTRODUCTION: Despite the recommendations to vaccinate annually against the flu to all the elderly and people with various chronic diseases, these recommendations are not comon to fulfill. In this case-control study performed in the service of Internal Medicine of the Hospital of Cáceres we have analyzed the degree of utilization of the flu vaccination in the season 2000/2001 in patients over 65 years of age with high-risk chronic diseases, as well as the effectiveness of this vaccination to avoid the hospitalization induced by cardiorespiratory decompensation, in order to reduce the number of consultations to the primary care physician and in order to reduce the issue of days of hospitalization. PATIENTS OF METHOD: 227 patients over 65 years of age with chronic cardiorespiratory disease, diabetes, chronic renal insufficiency, hepatopathy, previous pneumonia, or other causes of immunosuppression were studied. Of them, 116 were admitted because of cadiac or respiratory decompensation (cases); the control group was made up of 99 patients who went to outpatient consultations, with clinical manifestations similar to the cases and they were not hospitalized during the year of study. All the participants filled a questionnaire that included demographic characteristics and data about the underlying disease; the participants were grouped according to the number of underlying disease (one, two or more), according to if had received correctly the flu vaccination, according to the number of consultations to its Family doctor during the year of the study because of respiratory infections, according to the hospitalizations during the previous year and in the patients that were hospitalized acording to the number of days of the hospitalization. RESULTS: The average age was 71 years and 63% patients had been hospitalized the previous year. The percentage of vaccinated was of 60% and the vaccination was applied most frequently to the patients older than 75 years (p < 0.001), with EPOC (p < 0.005), and with cardiac insufficiency (p < 0.01), as well as to the patients with 2 or more risk factors (p < 0.001). Differences were not observed among the cases and the controls with regard to the age, to the incidence of ICC, to the incidence of DM, nor to the presence of 2 or more risk factors; however, the patients who were hospitalized presented a greater incidence of chronic obstructive pulmonary disease (COPD) (OR: 3.6; IC: 2.01-6.45) and of previous pneumonía (OR: 5.24: CI: 2.4-11-14): The factors most influencing the possibility of hospitalization were: EPOC (OR: 3.67; CI: 1.90-7.13); previous pneumonía (OR: 3.88: CI: 1.69-8.95). The estimate of hospitalizations avoided by the vaccination was of 59 (OR: 0.41; IC: 0.22-0.79). The vaccination did not decrease the number of consultations to the physician nor the days of the hospitalization. CONCLUSIONS: The flu vaccination looks underused in patients over 65 years of age with multiple diseases in the hospital environment. The vaccination seems to be effective in order to diminish the number of hospital admissions because of cardiorespiratory decompensation, even in non-epidemic seasons. We should insist on the use of the flu vaccination in these high-risk patients.

[Scurvy, a serious and rare form of avitaminosis, easily diagnosed and treated. Presentation of a case]. / Escorbuto, una grave y rara avitaminosis de fácil diagnóstico y tratamiento. Presentación de un caso.

We report a 66 years-old man case that was admitted with abdominal wall hemorrhagic swelling ecchymosis on inferior extremities and perifollicular purpura with hyperkeratosis of the follicles, which gives it an appearance of palpable purpura, together with gingival hemorrhage and moderate anemia. He was a well-nourished sick man but who made a peculiar diet, practically free from fruit and vegetables which developed a pure and serious form of scurvy. We report this case because we consider that the features which appear are illustrative to provide the immediate clinical diagnosis of this uncommon disease, potentially mortal, but easy to diagnose, if we think about it in the adequate clinical contexts, and which it is quickly curable with the administration of ascorbic acid.

[Brucellar hepatic abscess: presentation of a case and review of the literature]. / Absceso hepático brucelar: presentación de un caso y revisión de la literatura.

We present a case of a brucellar liver abscess in a 25-year-old male that was successfully treated by surgery and comment on this unusual form of brucellosis. We detail the complementary exams and how the diagnosis was achieved. We also review the 23 cases reported in the world literature, commenting on them from an etiological, clinical, diagnostic and therapeutic point of view in its two aspects: medical and surgical.