[Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital]. / Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel.

INTRODUCTION: Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. PATIENTS AND METHODS: A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. RESULTS: The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). DISCUSSION AND CONCLUSIONS: Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure.

¿Cómo se presenta la espondilitis infecciosa? / How does the infectious spondylodiscitis appear?

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Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel / Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital

Introducción. La insuficiencia cardíaca tiene una elevada incidencia y prevalencia en nuestra población. Los objetivos marcados en nuestro estudio son describir el perfil del paciente que ingresa en los servicios de Medicina Interna de nuestro hospital con objeto de analizar los aspectos terapéuticos y conocer el grado de utilización de los distintos grupos farmacológicos. Material y métodos. Se realiza un estudio transversal recogiendo datos de las historias clínicas de los pacientes ingresados en el año 2002 en los sevicios de Medicina Interna del Hospital Clínico San Carlos de Madrid con el diagnóstico de insuficiencia cardíaca. El total de pacientes con dichas características es de 1.338. Calculando el tamaño muestral con una precisión del 5% y un intervalo de confianza del 95%, el número de historias analizadas es de 130 escogidas de un modo aleatorio. Los datos se recogen mediante un cuestionario que analiza diferentes variables clínicas y terapéuticas. Resultados. La media de edad es de 80,3 (desviación estándar: 9,64) años, siendo en su mayoría mujeres. La patología asociada más frecuente es la hipertensión arterial, existiendo en un 70,2% de los pacientes alguna enfermedad. Los diuréticos son los fármacos más utlizados y su prescripción aumenta al alta (p < 0,0001). Además se prescriben más cuanto peor es la clase funcional. Los bloqueadores beta se prescriben en el 7,1% de los pacientes, más en pacientes con fracciones de eyección superiores al 35% (p = 0,042). Discusión y conclusiones. En nuestro medio los pacientes con IC tienen una edad avanzada, presentan una importante comorbilidad y una clase funcional avanzada, siendo los diuréticos su tratamiento de base. Observamos que no existe homogeneización en cuanto al tratamiento con respecto a las últimas recomendaciones y que hay una escasa utilización de los fármacos que, como los bloqueadores beta, han demostrado un aumento de la supervivencia en la insuficiencia cardíaca

Introduction. Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. Patients and methods. A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. Results. The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). Discussion and conclusions. Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure

Espondilodiscitis y absceso de psoas por Escherichia coli / Spondylodiscitis and psoas abscess caused by Escherichia coli

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[Neurocysticercosis: report of three cases and recommendations of treatment]. / Neurocisticercosis: recomendaciones de tratamiento a propósito de tres casos.

Neurocysticercosis is a pathology that we are finding nowadays over the immigrant population. It is produced by the Taenia solium parasite when it encyst into the central nervous system. The most frequent clinic is the focal crisis though it can come up as a general crisis; hydrocephalus, intracranial hypertension and even encephalitis can also happen. Its diagnosis is mainly based on imaging methods. The treatment is still controversial and must be individualized. The indication of antiparasitic drugs like albendazole and praziquantel has to be considered depending on the viability of the parasite, the number of cysts and their localization. If a cyst grows up the treatment is always recommended. In the case of an intracranial hypertension arises, this has to be treated before initiating any other action against the parasitic disease. Antiepileptic drugs are necessary to treat the symptoms. In some cases it is also recommended the use of steroids before and during the administration of antiparasitic therapy and even independently on their own.

Angiomiolipomatosis renal y esclerosis tuberosa / Renal angiomyolipoma and tuberous sclerosis complex

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Neurocisticercosis: recomendaciones de tratamiento a propósito de tres casos / Neurocysticercosis: report of three cases and recommendations of treatment

La neurocisticercosis es una patología que nos estamos encontrando actualmente en la población inmigrante. La produce el parásito Taenia solium cuando se enquista en el sistema nervioso central. La clínica más frecuente es la crisis focal aunque se puede presentar como crisis generalizada; pueden aparecer también hidrocefalia, hipertensión intracraneal e incluso encefalitis. Su diagnóstico se basa en estudios de neuroimagen fundamentalmente. El tratamiento aún es controvertido y se ha de individualizar. La indicación de antiparasitarios como el albendazol y el prazicuantel ha de considerarse según la viabilidad del parásito, el número de lesiones y su localización. Si un quiste crece siempre está indicado su tratamiento. En el caso de aparecer hipertensión intracraneal, ésta debe ser tratada antes de tomar ninguna otra medida contra la enfermedad parasitaria. Los antiepilépticos son necesarios para tratar los síntomas. En ocasiones también está recomendado el uso de esteroides antes y durante la administración de antiparasitarios e incluso de forma individual (AU)