ABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Anti-Bacterial Agents/therapeutic use , Central Serous Chorioretinopathy/microbiology , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/drug therapy , Helicobacter Infections/complications , Helicobacter Infections/diagnosisSubject(s)
Anti-Bacterial Agents/therapeutic use , Central Serous Chorioretinopathy/microbiology , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/drug therapy , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Humans , Male , Middle AgedSubject(s)
Chronic Disease/epidemiology , Multimorbidity , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prevalence , Sex Distribution , Spain/epidemiology , Young AdultABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Sweet Syndrome/etiology , Pulmonary Disease, Chronic Obstructive/complications , Adrenal Cortex Hormones/adverse effects , Aerosols/adverse effects , Pulmonary Disease, Chronic Obstructive/drug therapyABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/drug therapy , Drug Resistance , Iron/administration & dosage , Anemia, Refractory/complications , Anemia, Refractory/epidemiology , Ferrous Sulfate , Asthenia/complications , Disorders of Excessive Somnolence/complications , Medical History TakingSubject(s)
Anemia, Iron-Deficiency/drug therapy , Ferrous Compounds/administration & dosage , Proton Pump Inhibitors/adverse effects , Adult , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/physiopathology , Female , Humans , Proton Pump Inhibitors/administration & dosage , Treatment FailureABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Delirium/complications , Delirium/physiopathology , Dopamine Agents/administration & dosage , Dopamine Agents/adverse effects , Dopamine Agonists/adverse effects , Psychoses, Substance-Induced/complications , Parkinson Disease/epidemiology , Parkinson Disease/physiopathology , Psychoses, Substance-Induced/physiopathology , Psychotic Disorders/complicationsABSTRACT
AIM: To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. METHODS: Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n=65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. RESULTS: Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). CONCLUSION: In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.
Subject(s)
Comorbidity , Diabetes Mellitus, Type 2/complications , Emergency Medical Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Adolescent , Adult , Aged , Electronic Health Records , Female , Hospitalization , Humans , Longitudinal Studies , Male , Middle Aged , Regression Analysis , Retrospective Studies , Young AdultABSTRACT
La distonía se define como un trastorno caracterizado por la existencia de contracciones musculares mantenidas que frecuentemente determinan movimientos repetitivos y detorsión o posturas anómalas. La dificultad inherente al manejo del paciente psiquiátrico provoca, en algunas ocasiones, que la anamnesis no sea todo lo completa que debiera, por lo que cuadros como las distonías pueden pasar desapercibidos o bien ser diagnosticados como cuadros musculares banales. Presentamos dos casos en los que el tratamiento antipsicótico, con risperidona o con olanzapina, ha causado cuadros distónicos etiquetados inicialmente como contracturas musculares. Aunque la causa más frecuente de afectación muscular en Atención Primaria son las contracturas por sobrecarga y la incidencia de distonías, en los pacientes tratados con antipsicóticos atípicos es menor que en los que reciben haloperidol, ante cuadros como los descritos debería incluirse siempre en el diagnóstico diferencial la posibilidad de estar ante una reacción adversa (AU)
Dystonia is defined as a disorder characterized by the existence of sustained muscle contractions that frequently cause repetitive movements and twisting or abnormal postures. Because of the difficulty inherent to the management of the psychiatric patient, the anamnesis sometimes is not as complete as it should be. Thus, pictures such as dystonias may be overlooked or diagnosed as common muscle pictures. We present two cases in which the antipsychotic treatment with risperidone or with olanzapine have caused dystonic pictures that were initially labeled as muscle contractures. Although the most frequent cause of muscle problems in Primary Care are overload contractures and the incidence of dystonias in patients treated with atypical antipsychotics is less than in those who receive haloperidol, when there are pictures such as those described herein, the possibility that there may be an adverse reaction should also be included in the differential diagnosis (AU)
Subject(s)
Humans , Primary Health Care , Emergency Medical Services , Antipsychotic Agents/adverse effects , Dystonia/chemically inducedABSTRACT
INTRODUCTION: Presentation of signs and symptoms of haemorrhage and/or ischaemia associated to an intracranial dissecting aneurysm is quite frequent. CASE REPORT: A 77-year-old male with a history of a stroke probably due to a cardioembolic causation, and consequently anticoagulation therapy was established. Ten years later, a tomography scan performed because of persistent headaches revealed the presence of fusiform mirror aneurysms in both supraclinoid carotids and early stages of development in the two middle cerebral arteries with predominance of the left-hand side. The anticoagulation therapy was withdrawn. Said aneurysmal alterations did not exist in the previous study, and so they are thought to have originated due to spontaneous dissection. A month later the patient suffered a stroke in the territory of the right middle cerebral artery, caused by partial occlusion of the aneurysm by a thrombus that gave rise to turbulent flow; distal micro-embolisms were also detected in the right middle cerebral artery. Our aetiological hypothesis, in view of the way events progressed, is an arterio-arterial embolism from the aneurysmal thrombus. Supported by data from the specialised literature available on the matter, we decided to implement surgical treatment, although this possibility was rejected by the family; the decision was thus taken to establish an antiaggregating treatment regimen and follow-up. CONCLUSIONS: Giant aneurysms are a potential source of haemorrhagic events, but we must not forget that secondary ischaemic events may also appear; more especially, the aneurysmal lumen can become partially occluded by thrombi and these then become the focus point for embolic events. A complete neuro-ultrasonographic study would be a very appropriate option with which to tailor the therapeutic decision to each patient.
Subject(s)
Aneurysm/complications , Brain Ischemia/etiology , Carotid Artery Diseases/complications , Carotid Artery, Internal , Stroke/etiology , Aged , Aneurysm/pathology , Carotid Artery Diseases/pathology , Humans , MaleABSTRACT
La presentación de cuadros hemorrágicos y/o isquémicos asociados a un aneurisma disecante intracranealno es un hecho infrecuente. Caso clínico. Varón de 77 años, con antecedente de accidente cerebrovascular de probable origen cardioembólico, por lo que fue anticoagulado. Diez años después, tras realizarle una tomografía por cefalea persistente,se objetivaron aneurismas fusiformes en espejo en ambas carótidas supraclinoideas e inicio en ambas arterias cerebrales medias con predominio de la izquierda, por lo que se suspendió el tratamiento anticoagulante. Dichas alteraciones aneurismáticas no existían en el estudio previo, por lo que se presupone que se originaron por disección espontánea. Al mes, el paciente sufre un ictus agudo en el territorio de la arteria cerebral media derecha, debido a la oclusión parcial del aneurismapor un trombo que provoca un flujo turbulento, y además se detectan microembolias distales en la arteria cerebral media derecha. Nuestra hipótesis etiológica, según el desarrollo de los acontecimientos, es un embolismo arterioarterial desde eltrombo aneurismático. Apoyados por la bibliografía disponible, decidimos plantear un tratamiento quirúrgico, si bien éste fue rechazado por la familia, por lo que se decidió pautar tratamiento antiagregante y seguimiento. Conclusiones. Los aneurismasgigantes constituyen una fuente potencial de eventos hemorrágicos, pero no debemos olvidar que también pueden aparecer eventos isquémicos secundarios, en especial si puede ocluirse parcialmente la luz aneurismática mediante trombos y ser éstos un foco de eventos embólicos. El estudio neuroecográfico completo sería una opción muy adecuada con la que individualizarla decisión terapéutica de cada paciente
Presentation of signs and symptoms of haemorrhage and/or ischaemia associated to an intracranialdissecting aneurysm is quite frequent. Case report. A 77-year-old male with a history of a stroke probably due to a cardioembolic causation, and consequently anticoagulation therapy was established. Ten years later, a tomography scan performed because of persistent headaches revealed the presence of fusiform mirror aneurysms in both supraclinoid carotids and early stages of development in the two middle cerebral arteries with predominance of the left-hand side. The anticoagulation therapy was withdrawn. Said aneurysmal alterations did not exist in the previous study, and so they are thought to have originated due to spontaneous dissection. A month later the patient suffered a stroke in the territory of the right middle cerebral artery, caused by partial occlusion of the aneurysm by a thrombus that gave rise to turbulent flow; distal microembolisms were also detected in the right middle cerebral artery. Our aetiological hypothesis, in view of the way events progressed, is an arterio-arterial embolism from the aneurysmal thrombus. Supported by data from the specialised literature available on the matter, we decided to implement surgical treatment, although this possibility was rejected by the family; the decision was thus taken to establish an antiaggregating treatment regimen and follow-up. Conclusions. Giant aneurysms are a potential source of haemorrhagic events, but we must not forget that secondary ischaemic events may also appear; more especially, the aneurysmal lumen can become partially occluded by thrombi and these then become the focus point for embolic events. A complete neuro-ultrasonographic study would be a very appropriate option with which to tailor the therapeutic decision to each patient
