Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna / Mortality hospital of nonagenarian patients in Internal Medicine

Objetivos. Describir los factores predictivos de mortalidad hospitalaria en pacientes nonagenarios. Pacientes y método. Se estudió retrospectivamente a 421 pacientes ≥ 90 años ingresados en un servicio de Medicina Interna. Se analizó mediante regresión logística la asociación de parámetros demográficos, clínicos y funcionales con la mortalidad intrahospitalaria. Resultados. La edad media (DE) fue de 92,5 años (2,5), con 265 (62,9%) mujeres. Los principales diagnósticos fueron enfermedades infecciosas (257 pacientes, 61%) e insuficiencia cardiaca (183, 43,5%), y la estancia media fue de 11,9 días (8,6). Durante el ingreso fallecieron 96 pacientes (22,8%). Los factores predictivos de mortalidad fueron la edad (p = 0,002), el estado funcional (p = 0,006), la comorbilidad (p = 0,018) y los diagnósticos de neumonía (p = 0,001), sepsis (p = 0,012) e insuficiencia respiratoria (p < 0,001). Conclusión. La mortalidad hospitalaria de pacientes nonagenarios atendidos en Medicina Interna supera el 20% y se asocia a neumonía, carga de comorbilidad y deterioro funcional (AU)

Objectives. To describe the predictors of hospital mortality in nonagenarian patients. Patients and method. We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. Results. The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). Conclusion. The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment (AU)

Mortality hospital of nonagenarian patients in Internal Medicine. / Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna.

OBJECTIVES: To describe the predictors of hospital mortality in nonagenarian patients. PATIENTS AND METHOD: We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. RESULTS: The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). CONCLUSION: The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment.

Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction.

Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression.

Upper intestinal obstruction due to inverted intraduodenal diverticulum.

Inverted intraduodenal diverticulum is a rare congenital abnormality usually arising near the ampulla of Vater. We describe a case of an inverted duodenal diverticulum in a patient that presented with an upper recurrent intestinal obstruction that required surgery. Recognition of the entity and its anatomic relationships to the ampulla of Vater is essential to the prevention of iatrogenic complications. The inverted intraduodenal diverticulum must be considered in the management of upper intestinal obstruction of unclear origin.

Candida isolation in patients hospitalized on a surgical ward: significance and mortality-related factors.

BACKGROUND: Infections caused by Candida are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by Candida spp. in this setting. METHODS: A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for Candida were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined. RESULTS: The prevalence of patients colonized and/or infected by Candida on our surgical ward was 0.98% (CI 95%: 0.79-1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD +/- 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (p = 0.001); transfusions (p = 0.003), and an ICU stay (p = 0.002) were associated with mortality. Candidemia was associated with neoplasms (p = 0.02) and the infection caused by Candida parapsilosis (p = 0.04). The only independent factor related to mortality was the anemia (p = 0.028; Odds Ratio: 6.43; 95% CI: 1.23-33.73). CONCLUSIONS: Colonization and/or infection by Candida spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality.

Mesenteric venous thrombosis. Associated systemic disorders and hypercoagulability status of 21 surgical patients.

BACKGROUND/AIMS: Mesenteric venous thrombosis (MVT) is a rare condition with a challenging diagnosis. The aim of this study was to evaluate its association with systemic diseases and coagulation disorders. METHODOLOGY: Out of 132 patients operated on because of mesenteric ischemia between 1988 and 2002, all patients with a documented MVT were retrospectively recorded. Epidemiological and clinical data, complications and perioperative mortality were analyzed. RESULTS: Twenty-one patients, 10 male and 11 female, had MVT. Mean age was 63.8 years (SD: +/- 20.9). Arterial hypertension (57.1%) was the most prevalent associated condition. Other associated disorders were neoplasms (3 cases), liver cirrhosis (1 case), recurrent pulmonary thromboembolism (1 case), and one or more coagulation disorders (7 cases): lupus anticoagulant (2 cases); factor V Leiden (2 cases); protein S deficiency (3 cases); antithrombin III deficiency (1 case) and disseminated intravascular coagulation (1 case). Perioperative mortality was 33.3% (7 patients). Mean survival at the end of the study was 65.73 months (EE: 13.82). Patients with a coagulation disorder had a higher survival rate than those presenting without it (p = 0.02). CONCLUSIONS: MVT is still a lethal condition with a high morbidity that could be associated to systemic disorders and hypercoagulability syndromes in more than 50% of the cases.

Anticoagulación oral en nonagenarios / Oral anticoagulation in nonagenarians

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Características funcionales, cognitivas ycomorbilidad de ancianos ingresados / Functional, cognitive and comorbidity characteristics of the hospitalized elderly subjects

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Doble episodio de agranulocitosis probablemente causada por metamizol / Dual agranulocytosis episode likely resulting from metamizole use

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Pseudo-tumor of the lung, a rare clinical presentation of dirofilariasis.

INTRODUCTION: Pulmonary dirofilariasis is an uncommon entity. Known as a zoonotic disease it can affect humans as a secondary host. A pseudo-tumor of the lung called "coin" lesion is usually detected while performing a chest X-ray for another reason. OBSERVATION: We present a case of pulmonary dirofilariasis due to Dirofilaria sp. in a 72 year old immunocompetent patient who underwent surgery for suspicion of a neoplasm. DISCUSSION: Human pulmonary dirofilariasis should be evoked in asymptomatic patient from endemic area of canine dirofilariasis presenting with a pseudo tumor of the lung.

Nocardiosis in a tertiary care hospital on the island of Gran Canaria.

Background: Nocardiosis is an uncommon but serious infection increasingly found in immunosuppressed persons. We describe 14 cases of nocardial infection seen at a tertiary hospital. Methods: All positive Nocardia cultures isolated from 1991 to 2002 were included. We analyzed predisposing factors, epidemiological and clinical features, laboratory and radiological findings, site(s) of infection, antimicrobial susceptibility pattern, treatment, and outcome. Factors related to mortality were analyzed. Results: Nineteen patients with a Nocardia isolate were identified and 14 were finally included. The most common predisposing factors included pulmonary diseases (71.4%), diabetes mellitus (35.7%), systemic diseases (28.6%) and immunosuppressive therapy (28.6%). The site of infection was pulmonary in 12 cases (85.71%), cutaneous or subcutaneous in one case (7.1%), and disseminated in another case (7.1%). The predominant clinical symptom was purulent expectoration (71.4%) while the predominant radiological pattern was a reticulonodular infiltrate (6/12, 50%). Relapse was observed in one case (7.7%) and death in three cases (23.1%). Diabetes mellitus was associated with the mortality rate (p=0.035). Treatment was highly individualized, but trimethoprim (TMP)-sulfamethoxazole (SMX) was the combination most often used. Conclusions: Nocardiosis should be part of the differential diagnosis for patients presenting with pulmonary symptoms, soft tissue infection, or brain abscess.