Vitamina B12: ¿para algo más que el tratamiento de la anemia megaloblástica? / Vitamin B12: For more than just the treatment of megaloblastic anemia?

Vitamin B12, or cobalamin, belongs to the group of water-soluble vitamins and is ingested through food of animal origin such as eggs, milk, red meat and poultry, fish, and shellfish. Its clinical indication is the treatment of hypovitaminosis B12 administered orally or intramuscularly in the form of hydroxocobalamin. Hypovitaminosis B12 is mainly caused by deficient dietary intake (individuals with malnutrition, vegetarians or vegans, older adults, pregnant people, individuals with alcohol use disorder); when intestinal absorption is reduced (atrophic gastritis, malabsorption syndrome, gastrointestinal surgery); and for causes associated with the intake of drugs (antacids, metformin). Hypervitaminosis B12 has been associated with renal failure; liver diseases such as cirrhosis and acute-phase hepatitis; alcohol use disorder with or without liver involvement; solid tumors of the lung, liver, esophagus, pancreas, and colorectum; and in hematological malignancies such as leukemia and bone marrow dysplasia (AU)

La vitamina B12 o cobalamina pertenece al grupo de vitaminas hidrosolubles y su aporte se realiza a través de la ingesta de alimentos de origen animal como huevo; leche; carnes rojas y de aves; pescados y mariscos. Su indicación clínica es el tratamiento de la hipovitaminosis B12 administrada por vía oral o intramuscular en forma de hidroxicobalamina. La hipovitaminosis B12 se origina, principalmente, por un déficit de aporte en la dieta (malnutrición, sujetos vegetarianos o veganos, ancianos, embarazo, alcoholismo); cuando está disminuida su absorción intestinal (gastritis atrófica, síndrome de malabsorción intestinal, cirugía gastro-intestinal) y asociada a ingesta de fármacos (antiácidos, metformina). La hipervitaminosis B12 se ha relacionado con la insuficiencia renal; hepatopatías como cirrosis y hepatitis en fase aguda; alcoholismo con o sin afectación hepática; tumores sólidos de pulmón, hígado, esófago, páncreas y colorrectal y en neoplasias hematológicas como leucemia y la displasia medular (AU)

Vitamin B12: For more than just the treatment of megaloblastic anemia?

Vitamin B12, or cobalamin, belongs to the group of water-soluble vitamins and is ingested through food of animal origin such as eggs, milk, red meat and poultry, fish, and shellfish. Its clinical indication is the treatment of hypovitaminosis B12 administered orally or intramuscularly in the form of hydroxocobalamin. Hypovitaminosis B12 is mainly caused by deficient dietary intake (individuals with malnutrition, vegetarians or vegans, older adults, pregnant people, individuals with alcohol use disorder); when intestinal absorption is reduced (atrophic gastritis, malabsorption syndrome, gastrointestinal surgery); and for causes associated with the intake of drugs (antacids, metformin). Hypervitaminosis B12 has been associated with renal failure; liver diseases such as cirrhosis and acute-phase hepatitis; alcohol use disorder with or without liver involvement; solid tumors of the lung, liver, esophagus, pancreas, and colorectum; and in hematological malignancies such as leukemia and bone marrow dysplasia.

Mortalidad hospitalaria asociada a medicamentos en un Servicio de Medicina Interna / Drug-related mortality among inpatients admitted in Internal Medicine

Fundamento: Analizar la mortalidad asociada a fármacos, los medicamentos más implicados y los factores de riesgo asociados en pacientes ingresados en Medicina Interna. Material y métodos: Estudio retrospectivo, observacional. Se revisaron las historias clínicas de los adultos fallecidos consecutivamente en el servicio de Medicina Interna de un hospital universitario durante veintidós meses. La variable principal fue la mortalidad hospitalaria sospechosa de estar relacionada con medicamentos administrados durante el ingreso. Resultados: De las 455 muertes analizadas, el 22,2% estuvieron relacionadas con los medicamentos recibidos; en 55 casos (12,1%) los medicamentos fueron considerados sospechosos de ser la causa de la muerte y en 46 casos (10,1%) de contribuir a ello. Los diagnósticos más frecuentes en los casos de muerte asociada a medicamentos fueron arritmia cardiaca (23,7%), hemorragia grave (19,8%) y neumonía aspirativa (12,8%). Los medicamentos implicados con mayor prevalencia en las muertes relacionadas con el tratamiento farmacológico fueron los antitrombóticos (23,7 %), la digoxina (21,7 %), los antipsicóticos (17,8%) y las benzodiacepinas (14,8%). El único factor de riesgo independiente de mortalidad asociada a tratamiento fue el número de medicamentos administrados (OR=1,25; IC95%: 1,14-1,37). No se encontró asociación significativa con la edad, sexo, número de patologías o duración de la estancia hospitalaria. Conclusiones: Un alto porcentaje de las muertes de pacientes ingresados en Medicina Interna se consideran relacionadas con los medicamentos recibidos. Los antitrombóticos, digoxina y psicofármacos fueron los agentes más frecuentemente implicados. Dicha mortalidad se asocia de manera independiente y significativa con el número de medicamentos administrados

Background: To analyze the mortality associated with prescriptions, the drugs most frequently involved and the associated risk factors in patients admitted to Internal Medicine. Methods: A retrospective, observational study. The clinical records of adult patients who died consecutively in the department of Internal Medicine in a Spanish tertiary hospital over twenty-two months were reviewed. The main variable was the prevalence of hospital death suspected of being related to the medications administered during admission. Results: Out of the 455 deaths analyzed, 22.2% were related to the medications received; in 55 cases (12.1%) the drugs were suspected of being the cause of death and in 46 cases (10.1%) of contributing to it. The most frequent diagnoses in cases of death associated with drugs were cardiac arrhythmia (23.7%), severe hemorrhage (19.8%) and aspiration pneumonia (12.8%). The drugs with the highest prevalence in deaths related to pharmacological treatment were antithrombotic drugs (23.7%), digoxin (21.7%), antipsychotics (17.8%) and benzodiazepines (14.8%). The only independent risk factor for mortality associated with treatment was the number of medications administered (OR=1.25, 95%CI: 1.14-1.37). No significant association was found with age, sex, number of pathologies or duration of hospital stay. Conclusion: A high percentage of deaths of patients admitted to Internal Medicine were considered related to the medications received. Antithrombotic drugs, digoxin and psychotropic drugs were the agents most frequently implicated. This mortality is independently and significantly associated with the number of medications administered

[Drug-related mortality among inpatients admitted in Internal Medicine]. / Mortalidad hospitalaria asociada a medicamentos en un Servicio de Medicina Interna.

BACKGROUND: To analyze the mortality associated with prescriptions, the drugs most frequently involved and the associated risk factors in patients admitted to Internal Medicine. METHODS: A retrospective, observational study. The clinical records of adult patients who died consecutively in the department of Internal Medicine in a Spanish tertiary hospital over twenty-two months were reviewed. The main variable was the prevalence of hospital death suspected of being related to the medications administered during admission. RESULTS: Out of the 455 deaths analyzed, 22.2% were related to the medications received; in 55 cases (12.1%) the drugs were suspected of being the cause of death and in 46 cases (10.1%) of contributing to it. The most frequent diagnoses in cases of death associated with drugs were cardiac arrhythmia (23.7%), severe hemorrhage (19.8%) and aspiration pneumonia (12.8%). The drugs with the highest prevalence in deaths related to pharmacological treatment were an-tithrombotic drugs (23.7%), digoxin (21.7%), antipsychotics (17.8%) and benzodiazepines (14.8%). The only independent risk factor for mortality associated with treatment was the number of medications administered (OR=1.25, 95%CI: 1.14-1.37). No significant association was found with age, sex, number of pathologies or duration of hospital stay. CONCLUSION: A high percentage of deaths of patients admitted to Internal Medicine were considered related to the medications received. Antithrombotic drugs, digoxin and psychotropic drugs were the agents most frequently implicated. This mortality is independently and significantly associated with the number of medications administered.

Respuesta a "Intervención de las unidades de gestión clínica de medicina física y rehabilitación en la enfermedad cerebrovascular" / Reply to "Intervention of clinical management units of physical medicine and rehabilitation in cerebrovascular disease"

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[Potentially inappropriate prescribing in hospitalized patients with comparative study between prescription by internist and geriatricians]. / Prescripción potencialmente inapropiada en pacientes hospitalizados con estudio comparativo entre la prescripción y realizada por internistas y geriatras.

OBJECTIVES: To analyze potentially inappropriate prescribing in hospitalized patients and compare the prescription by internists and geriatricians. METHODS: Cross-sectional study in hospitalized patients older than 65 years. We recorded prevalence of potentially inappropriate prescriptions according to the criteria of "Screening Tool of Older Person's Prescriptions". RESULTS: We included 95 hospitalized patients over 65 years with a median age of 79 years (interquartile range: 73-82 years) and 50.5% female. One hundred eighty-three potentially inappropriate prescriptions were detected in 81 patients (85.2% of patients). The most frequent potentially inappropriate prescription were the prolonged use of inhibitors of proton pump high dose (32.6% of patients), the use of benzodiazepines in patients prone to falling (23.2% of patients), the prolonged use of long-acting benzodiazepines (21.1% of patients) and prolonged use of neuroleptic as hypnotics (21.1% of patients). In comparative study between medical specialties, significant differences were found in mean number of drugs (P = 0.0001) and in prolonged use of neuroleptics as hypnotics (P = 0.015). CONCLUSIONS: A high percentage of hospitalized patients older than 65 years receive potentially inappropriate prescribing. Prolonged use of inhibitors of the proton pump at high doses was the most frequent potentially inappropriate prescribing criterion.

Prescripción potencialmente inapropiada en pacientes hospitalizados con estudio comparativo entre la prescripción realizada por internistas y geriatras / Potentially inappropriate prescribing in hospitalized patients with comparative study between prescription by internist and geriatricians

Objetivos: Analizar la prescripción potencialmente inapropiada en pacientes hospitalizados y comparar la prescripción realizada por internistas y geriatras. Métodos: Estudio transversal en pacientes mayores de 65 años hospitalizados. Se registraron las prevalencias de las prescripciones potencialmente inapropiadas según los criterios de "Screening Tool of Older Person's Prescriptions". Resultados: Se incluyeron 95 pacientes hospitalizados mayores de 65 años con una mediana de edad de 79 años (rango intercuartílico: 73-82 años) y un 50,5% fueron mujeres. En 81 pacientes (85,2% de la muestra) se detectaron un total de 183 prescripciones potencialmente inadecuadas. Los criterios de prescripciones potencialmente inadecuadas más frecuentes fueron el uso prolongado de los inhibidores de la bomba de protones a altas dosis (32,6% de los pacientes), el uso de benzodiacepinas en pacientes propensos a las caídas (23,2% de los pacientes), el uso prolongado de benzodiacepinas de vidamedia larga (21,1% de los pacientes) y el uso prolongado de neurolépticos como hipnóticos (21,1% de los pacientes). En el estudio comparativo entre especialistas, se encontraron diferencias significativas en el número medio de fármacos/paciente (P = 0,0001) y en el uso prolongado de neurolépticos como hipnóticos (P = 0,015). Conclusiones: Un alto porcentaje de los pacientes mayores de 65 años hospitalizados reciben una prescripción potencialmente inapropiada. El uso prolongado de los inhibidores de la bomba de protones a altas dosis fue el criterio de prescripción potencialmente inapropiada más frecuente

Objectives: To analyze potentially inappropriate prescribing in hospitalized patients and compare the prescription by internists and geriatricians. Methods: Cross-sectional study in hospitalized patients older than 65 years. We recorded prevalence of potentially inappropriate prescriptions according to the criteria of "Screening Tool of Older Person's Prescriptions". Results: We included 95 hospitalized patients over 65 years with a median age of 79 years (interquartile range: 73-82 years) and 50.5% female. One hundred eighty-three potentially inappropriate prescriptions were detected in 81 patients (85.2% of patients). The most frequent potentially inappropriate prescription were the prolonged use of inhibitors of proton pump high dose (32.6% of patients), the use of benzodiazepines inpatients prone to falling (23.2% of patients), the prolonged use of long-acting benzodiazepines (21.1% of patients) and prolonged use of neuroleptic as hypnotics (21.1% of patients). Incomparative study between medical specialties, significant differences were found in mean number of drugs (P = 0.0001) and in prolonged use of neuroleptics as hypnotics (P = 0.015). Conclusions: A high percentage of hospitalized patients olderthan 65 years receive potentially inappropriate prescribing. Prolonged use of inhibitors of the proton pump at high doses was the most frequent potentially inappropriate prescribing criterion

Implementación de las guías de práctica clínica sobre ictus isquémico agudo en atención especializada / Implementation of clinical practice guidelines for acute ischaemic stroke in specialist

Introducción: La enfermedad cerebrovascular se asocia a una elevada morbimortalidad. En el año 2008, el Ministerio de Sanidad publicó la «Guía de práctica clínica» sobre prevención del ictus sin que se haya evaluado su implementación. Nos planteamos investigar el seguimiento de dicha guía a través del análisis del control de factores de riesgo vascular y el tratamiento antitrombótico e hipolipemiante en pacientes con ictus isquémico agudo atendidos por neurólogos o internistas. Métodos: Estudio transversal descriptivo basado en los datos obtenidos de informes clínicos factores de riesgo vascular, diagnóstico y tratamientos), cifras tensionales y analíticas de 203 pacientes con diagnóstico principal de ictus isquémico agudo que ingresaron para rehabilitación y cuidados en un hospital de media-larga estancia. Resultados: La edad media ± DE de los pacientes incluidos fue de 75 ± 10 años con un 56% de mujeres. Los factores de riesgo más frecuentes fueron hipertensión arterial (68%) y diabetes mellitus (40%). El 8,9% de los pacientes había recibido fibrinólisis por vía intravenosa. El 91,7% de los pacientes con ictus aterotrombótico recibía antiagregantes; el 59,4% de los pacientes con ictus cardioembólico estaba anticoagulado. Se prescribieron estatinas al 65% de los pacientes con ictus aterotrombótico. En la analítica de ingreso, el 23% de los pacientes presentaba una colesterolemia total mayor de 175 mg/dl y el 26,6% una glucemia plasmática mayor de 126 mg/dl. El 70% de los pacientes tenía tratamiento antihipertensivo, aunque el 47,5% presentaba cifras tensionales mayores de 130/80 mmHg. Conclusiones: Creemos que aún es posible mejorar la prevención secundaria en enfermedad cerebrovascular, principalmente aumentando el porcentaje de pacientes tratados con antiagregantes o anticoagulantes según la etiología, la prescripción de estatinas y mejorando el control tensional (AU)

Introduction: Cerebrovascular disease is associated with high morbidity and mortality. In 2008, the Spanish Ministry of Health published its Clinical Practice Guidelines for stroke prevention, but implementation of that document has not yet been assessed. Our study aims to investigate compliance with the Guidelines by analysing control over vascular risk factors, antithrombotic treatment and lipid lowering treatment in patients who had suffered an acute ischaemic stroke and who were under the care of neurologists or internists. Methods: Cross-sectional study based on data from clinical reports (vascular risk factors, diagnosis and treatment), blood pressure readings and laboratory tests pertaining to 203 patients diagnosed with acute ischaemic stroke and admitted to a medium-to-long stay hospital for rehabilitation and care. Results: The mean patient age was 75 ± 10 years; 56% were women. The most common risk factors were hypertension (68%) and diabetes mellitus (40%). Intravenous fibrinolytic therapy had been administered to 8.9% of the patients. Of the patients with thrombotic cerebral infarction, 91.7% received antiplatelet agents; 59.4% of patients with embolic infarction received anticoagulants. Statins were prescribed to 65% of patients with thrombotic infarction. Laboratory tests upon admission showed that 23% of patients had total cholesterol levels above 175 mg/dl and 26.6% had plasma glucose levels above 126 mg/dl. Of the patient total, 70% received antihypertensive therapy, but 47.5% had blood pressure levels above 130/80 mm Hg. Conclusions: In our opinion, secondary prevention of acute cerebrovascular disease could be improved, mainly by increasing the percentage of patients treated with antiplatelet or anticoagulant drugs (depending on aetiology), increasing prescription of statins, and improving blood pressure control (AU)

Implementation of clinical practice guidelines for acute ischaemic stroke in specialist care centres.

INTRODUCTION: Cerebrovascular disease is associated with high morbidity and mortality. In 2008, the Spanish Ministry of Health published its Clinical Practice Guidelines for stroke prevention, but implementation of that document has not yet been assessed. Our study aims to investigate compliance with the Guidelines by analysing control over vascular risk factors, antithrombotic treatment and lipid lowering treatment in patients who had suffered an acute ischaemic stroke and who were under the care of neurologists or internists. METHODS: Cross-sectional study based on data from clinical reports (vascular risk factors, diagnosis and treatment), blood pressure readings and laboratory tests pertaining to 203 patients diagnosed with acute ischaemic stroke and admitted to a medium-to-long stay hospital for rehabilitation and care. RESULTS: The mean patient age was 75 ± 10 years; 56% were women. The most common risk factors were hypertension (68%) and diabetes mellitus (40%). Intravenous fibrinolytic therapy had been administered to 8.9% of the patients. Of the patients with thrombotic cerebral infarction, 91.7% received antiplatelet agents; 59.4% of patients with embolic infarction received anticoagulants. Statins were prescribed to 65% of patients with thrombotic infarction. Laboratory tests upon admission showed that 23% of patients had total cholesterol levels above 175 mg/dl and 26.6% had plasma glucose levels above 126 mg/dl. Of the patient total, 70% received antihypertensive therapy, but 47.5% had blood pressure levels above 130/80 mm Hg. CONCLUSIONS: In our opinion, secondary prevention of acute cerebrovascular disease could be improved, mainly by increasing the percentage of patients treated with antiplatelet or anticoagulant drugs (depending on aetiology), increasing prescription of statins, and improving blood pressure control.