Functional status determined by Barthel Index predicts community acquired pneumonia mortality in general population.

BACKGROUND: Barthel Index (BI) measures functional status. Our aim was to analyze if BI and other factors not included in Pneumonia Severity Index (PSI) predict mortality in general population with community acquired pneumonia (CAP). METHODS: Prospective observational study including all patients with CAP diagnosed in 2006. Endpoint of study: 30-day mortality. Variables not included in PSI as BI were analyzed. Strength of association was determined by odds ratio (OR) with 95% confidence interval. RESULTS: 550 patients, mean age of 60.3 ± 20.8, were included. 32 were lost during follow-up and 518 patients were finally analyzed. 44 (8.5%) patients died in the first 30 days after CAP diagnosis. In bivariate analysis, mortality was significantly more frequent in patients with PSI ≥ IV (19.2% vs 1.9%), BI≤80 points (23.9% vs 2.9%), multilobar infiltrate (20% vs 6%), diabetes mellitus (14.9% vs 6.5%), influenza vaccination (11.9% vs 6.6%) and pneumococcal vaccination (16.7% vs 6%). In multivariate analysis, mortality independently associated factors were: BI ≤80, OR: 3.9(CI95% 1.4-10.5; p < 0.001); PSI ≥ IV OR: 3.9(1.2-12.7; p < 0.05); and multilobar infiltrate OR: 2.9(1.1-7.3; p = 0.05). CONCLUSION: A BI score ≤80 is associated with a higher mortality in patients with CAP independently of the PSI. BI can be a useful tool to predict CAP mortality in general population.

[Clinical experience with levosimendan in the emergency department of a tertiary care hospital]. / Experiencia clínica con levosimendán en un servicio de urgencias de un hospital de tercer nivel.

The efficacy and safety of levosimendan administration in patients with acute heart failure admitted to intensive care units has been well established. However, no information is available on the drug's beneficial effects in emergency departments. We studied 40 patients with acute heart failure who showed no or only partial improvement after conventional treatment and who received levosimendan during the period 2005-2006. The patients' mean age was 76 (9) years. The most common etiology was ischemic heart disease, and 85% of patients were in New York Heart Association (NYHA) class III or IV. The clinical response was favorable in 82% of patients, while adverse effects occurred in 18%. Some 70% were admitted to the emergency department short-stay unit. These findings indicate that levosimendan can be used safely and effectively in hospital emergency departments.

Experiencia clínica con levosimendán en un servicio de urgencias de un hospital de tercer nivel / Clinical experience with levosimendan in the emergency department of a tertiary care hospital

La eficacia y la seguridad de la administración de levosimendán en las unidades de cuidados intensivos en pacientes con insuficiencia cardiaca aguda está bien establecida, pero no hay pruebas científicas de sus efectos favorables en los servicios de urgencias (SUH). Hemos estudiado a 40 pacientes con insuficiencia cardiaca aguda con ausencia de mejoría o mejoría parcial tras tratamiento convencional a los que se administró levosimendán entre 2005 y 2006. La media de edad fue de 76 ± 9 años. La cardiopatía isquémica fue la etiología más frecuente; el 85% de los pacientes se encontraba en estadio III-IV de la New York Heart Association. La respuesta clínica fue favorable en un 82% de los pacientes y sólo un 18% presentó efectos adversos. El 70% de los pacientes ingresó en la unidad de corta estancia dependiente del SUH. Los resultados obtenidos indican que levosimendán puede utilizarse de forma segura y eficaz en los SUH (AU)

The efficacy and safety of levosimendan administration in patients with acute heart failure admitted to intensive care units has been well established. However, no information is available on the drug's beneficial effects in emergency departments. We studied 40 patients with acute heart failure who showed no or only partial improvement after conventional treatment and who received levosimendan during the period 2005-2006. The patients' mean age was 76 (9) years. The most common etiology was ischemic heart disease, and 85% of patients were in New York Heart Association (NYHA) class III or IV. The clinical response was favorable in 82% of patients, while adverse effects occurred in 18%. Some 70% were admitted to the emergency department short-stay unit. These findings indicate that levosimendan can be used safely and effectively in hospital emergency departments (AU)

Ceftazidima en infusión continua en el tratamiento de infecciones por Pseudomonas aeruginosa en una Unidad de Hospitalización a Domicilio / Continuous Ceftazidime infusion in the treatment of Pseudomonas aeruginosa infections in a Hospital at Home Unit

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