Factores de riesgo de mortalidad tras intervención quirúrgica de fractura de cadera osteoporótica en pacientes mayores / Risk factors for mortality after surgery of osteoporotic hip fracture in patients over 65 years of age

Objetivo. Valorar desde una perspectiva clínica y con variables fácilmente identificables aquellos factores que influyen en la supervivencia de los pacientes ingresados en una unidad asistencial diseñada para el tratamiento integral de pacientes con fractura de cadera, tras ser intervenidos quirúrgicamente. Material y método. Estudio prospectivo de una cohorte de pacientes (n=202) de edad igual o mayor de 65 años con fractura de cadera de bajo impacto, intervenidos quirúrgicamente en un hospital terciario, que analizó la mortalidad a 90 días, 1 y 2años tras la intervención con relación a variables demográficas, clínicas, analíticas y de funcionalidad. Resultados. Los factores de riesgo independientes de mortalidad en los 3periodos analizados fueron la edad (p=0,047; 0,016 y 0,000 a 90 días, 1 y 2 años, respectivamente) y el bajo índice de Barthel (p=0,014; 0,005 y 0,004 a 90 días, 1 y 2 años respectivamente). Sin embargo, el sexo masculino (p=004) y el riesgo para anestesia (p=0,011) resultaron ser solo factores de riesgo independientes de mortalidad a los 2años de la intervención quirúrgica. Discusión y conclusión. Tanto a corto plazo (30 días) como hasta los 2 años de la intervención quirúrgica por fractura de cadera los mayores condicionantes de mortalidad fueron la edad y la dependencia. Ambos son parámetros fácilmente medibles que permiten identificar a pacientes susceptibles de mala evolución desde el ingreso y que podrían beneficiarse de una atención más exhaustiva (AU)

Objective. To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. Material and methods. A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. Results. The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. Discussion and conclusion. Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan (AU)

Risk factors for mortality after surgery of osteoporotic hip fracture in patients over 65 years of age. / Factores de riesgo de mortalidad tras intervención quirúrgica de fractura de cadera osteoporótica en pacientes mayores.

OBJECTIVE: To evaluate, from a clinical perspective, and with easily identifiable variables, those factors that influence the survival of patients admitted to a care unit designed for the comprehensive treatment of patients with hip fracture after being surgically treated. MATERIAL AND METHODS: A prospective study was conducted on a cohort of patients (n=202) aged 65 years or older with a low impact hip fracture, who were surgically intervened in a tertiary hospital. An analysis was performed to determine mortality at 90 days, and at one and 2years after surgery using demographic, clinical, analytical, and functional variables. RESULTS: The independent risk factors of mortality in the 3periods analysed were age (P=.047, P=.016, and P=.000 at 90 days, 1, and 2 years, respectively) and a low Barthel index (P=.014, P=.005, and P=.004 to 90 days, 1, and 2 years, respectively). Male sex (P=.004) and a high risk for anaesthesia (P=.011) were only independent risk factors of mortality at 2years after surgery. DISCUSSION AND CONCLUSION: Age and dependency were the major determining factors of mortality at 30 days, 1, and 2 years after surgery for hip fracture. Both are easily measurable to identify patients susceptible to poor outcomes, and could benefit from a more thorough care plan.

[Chronic Salmonella typhimurium diarrhea in an immunocompetent patient]. / Diarrea crónica por Salmonella typhimuriumen paciente inmunocompentente.

Chronic diarrhea caused by infection in immunocompetent patients is an infrequent condition in developed countries, although certain pathogens,generally parasites (Giardia lamblia, Isospora belli,Cryptosporidium, Cyclospora, Strongyloides, Ameba,Trichuris and Schistosoma) and some bacteria (Aeromonas,Plesiomonas, Campylobacter, Clostridium difficile, Salmonella or Mycobacterium tuberculosis)can cause persistent diarrhea.We present the case of a patient who showed Salmonella typhimurium in his stool culture and recovered following treatment with levofloxacin for 7 days.

Diarrea crónica por Salmonella typhimurium en paciente inmunocompentente / Chronic Salmonella typhimurium diarrhea in an immunocompetent patient

La diarrea crónica de origen infeccioso en pacientes inmunocompetentes es un cuadro poco frecuente en países desarrollados, aunque ciertos patógenos, generalmente parásitos (Giardia lamblia, Isospora belli, Cryptosporidium, Cyclospora, Strongyloides, Ameba, Trichuris y Schistosoma) y algunas bacterias (Aeromonas, Plesiomonas, Campylobacter, Clostridium difficile, Salmonella o Mycobacterium tuberculosis) pueden ser causantes de diarrea persistente. Se presenta un caso de un paciente que presentó Salmonella typhimunium en el coprocultivo y se recuperó tras tratamiento con levofloxacino durante 7 días (AU)

Chronic diarrhea caused by infection in immunocompetent patients is an infrequent condition in developed countries, although certain pathogens, generally parasites (Giardia lamblia, Isospora belli, Cryptosporidium, Cyclospora, Strongyloides, Ameba, Trichuris and Schistosoma) and some bacteria (Aeromonas, Plesiomonas, Campylobacter, Clostridium difficile, Salmonella or Mycobacterium tuberculosis) can cause persistent diarrhea. We present the case of a patient who showed Salmonella typhimurium in his stool culture and recovered following treatment with levofloxacin for 7 days (AU)

Multiingreso en el Servicio de Medicina Interna de un hospital terciario / Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital

Antecedentes y objetivos. El paciente multiingresador origina un gran consumo de recursos sanitarios. Hemos estudiado los factores asociados con el ingreso hospitalario múltiple en una cohorte de pacientes asistidos en un Servicio de Medicina Interna. Pacientes y métodos. Se analizaron 613 ingresos hospitalarios consecutivos. Se definió como paciente multiingresador a aquel que al ingresar contabilizaba 3 ingresos o más en los últimos 12 meses. Se analizó la relación de factores demográficos, clínicos y sociales con la característica de ser multiingresador. Además, se analizó el reingreso en los 6 meses siguientes al alta así como el fallecimiento en el ingreso y en los 6 y 12 meses siguientes al alta. Resultados. Los multiingresadores se caracterizaron frente a los no multiingresadores por ser de sexo masculino, ser más jóvenes y presentar mayor comorbilidad, mayor consumo de medicaciones y mayor puntuación en el índice de Katz. La principal causa de ingreso de los multiingresadores fue la «descompensación de una enfermedad crónica» (87,3%). Las enfermedades que se asociaron de forma más destacada con el multiingreso fueron la insuficiencia cardiaca, la diabetes mellitus y la enfermedad pulmonar obstructiva crónica. En los 6 primeros meses tras el alta los multiingresadores presentaron más reingresos. Durante el periodo de estudio, falleció el 40,4% de los pacientes multiingresadores y el 28,8% de los pacientes no multiingresadores. Conclusiones. Los pacientes multiingresadores presentaron mayor complejidad clínica que los no multiingresadores, y el multiingreso se asoció con las enfermedades crónicas, la polifarmacia, el deterioro funcional y tasas elevadas de mortalidad (AU)

Background and objectives. Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. Patients and methods. A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. Results. When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. Conclusions. Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates (AU)

Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital. / Multiingreso en el Servicio de Medicina Interna de un hospital terciario.

BACKGROUND AND OBJECTIVES: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. RESULTS: When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. CONCLUSIONS: Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

[Study of quality of life of patients with heart failure in an Internal Medicine Department]. / Estudio de la calidad de vida de pacientes con insuficiencia cardiaca en un Servicio de Medicina Interna.

INTRODUCTION: Quality of life (QL) is an important objective in the treatment of patients with heart failure (HF). We have measured QL and different factors that can affect it in a group of patients hospitalized with HF. METHODS: 34 patients with HF were cross-examined by means of a specific questionnaire: The "Minnesota Living With Heart Failure Questionnaire" (MLWHFQ). Blood analyses, ecocardiographic measurements and specific questionnaires, were also carried out in order to evaluate other parameters which could affect QL: Age, sex, comorbidity, number of drugs taken, left ventricular ejection fraction, nutritional status, cognitive function, depression and functional capacity in daily life. RESULTS: QL measured by means of the MLWHFQ was quite high (mean: 34.3). The other tests yielded values within normality or next to normality. Depression was the factor more clearly associated with patients quality of life (p = 0.0001). We also found a statistically significant association with left ventricular ejection fraction (p = 0.03), age (p = 0.008) and albuminemia (p = 0.01). CONCLUSIONS: In our group of patients, QL was conditioned by depression, left ventricular ejection fraction, age and albuminemia.

Estudio de la calidad de vida de pacientes con insuficiencia cardíaca en un Servicio de Medicina Interna / Study of qulaity of life of patients with heart failure in an internal medicine department

Introducción: la calidad de vida (CV) es un objetivo importante del tratamiento de los pacientes con insuficiencia cardiaca (IC). Hemos medido la CV en una muestra de pacientes ingresados que presentan IC y diversos factores que pueden influir en ella. Métodos: se evaluó a 34 pacientes con IC utilizando un cuestionario específico, el Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Además se realizaron mediciones analíticas y de ecocardiografía y se aplicaron cuestionarios específicos con el fin de evaluar otros parámetros que pueden influir en la CV: la edad, el sexo, la comorbilidad, la medicación habitual, la fracción de eyección del ventrículo izquierdo, el estado nutricional, la función cognitiva, la depresión y la capacidad funcional en la vida diaria. Resultados: la CV medida mediante el cuestionario MLWHFQ de los pacientes del estudio fue alta (media: 34,3). Los otros tests realizados dieron valores dentro de la normalidad o próximos a ella. La depresión fue el factor que con más claridad se asoció con la CV de los pacientes (p = 0,0001). También demostraron una asociación estadísticamente significativa la fracción de eyección del ventrículo izquierdo (p=0.03), la edad (p = 0,008) y la albuminemia (p = 0,01). Conclusiones: En nuestra muestra, la CV de los pacientes estaba condicionada por la depresión, la fracción de eyección del ventrículo izquierdo, la edad y la albuminemia

Introduction: Quality of life (QL) is an important objective in the treatment of patients with heart failure (HF). We have measured QL and different factors that can affect it in a group of patients hospitalized with HF. Methods: 34 patients with HF were cross-examined by means of a specific questionnaire: The “Minnesota Living With Heart Failure Questionnaire” (MLWHFQ). Blood analyses, ecocardiographic measurements and specific questionnaires, were also carried out in order to evaluate other parameters which could affect QL: Age, sex, comorbilidity, number of drugs taken, left ventricular ejection fraction, nutritional status, cognitive function, depression and functional capacity in daily life. Results: QL measured by means of the MLWHFQ was quite high (mean: 34.3). The other tests yielded values within normality or next to normality. Depression was the factor more clearly associated with patients’ quality of life (p = 0.0001 ). We also found a statistically significant association with left ventricular ejection fraction (p = 0.03), age (p = 0.008 ) and albuminemia (p = 0.01 ). Conclusions: In our group of patients, QL was conditioned by depression, left ventricular ejection fraction, age and albuminemia

Varón de 55 años con hipertensión pulomnar de aparición subaguda / 55-year-old male with subacute appearance of pulmonary hypertension

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