[Hospital mortality in the Internal Medicine Services of a first level center]. / Mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital de primer nivel.

BACKGROUND AND OBJECTIVE: Hospital mortality is a indicator of quality of care, and their study may improve assistance of hospitalized patients. Our objective was to know the most frequent death causes of hospitalized patients, to identify clinical and analytical variables associated with each cause, and to determine gender differences. MATERIAL AND METHODS: A systematic and retrospective revision of 113 medical reports of death patients was carried out; it corresponded 26% of all deaths occurred between March 2002 to November 2004. At each case, epidemiological variables, previous clinical reports, biochemical and haematological parameters, death cause and in-hospital complications were registered. RESULTS: Mean age was 79 +/- 10 years and 58.4% of cases were males. Thirty eight percent had previous admission, and 45% had functional class III-IV. Men died with less age that women (76.6 +/- 10.3 versus 82.3 +/- 8.0 p < 0.002) and they had more frequent antecedents of chronic bronchopulmonary disease (43% versus 19%, p <0.04); however, women had worse ventilatory situation at admission. The main death causes were cardiopulmonary (56% whole, 34% because of respiratory insufficience, 14% because of pneumonia, and 8% because of acute lung oedema), followed by neurological causes (25% whole, 23% because of stroke) and 19% because another reason (neoplasia, multiorganic failure, hepatic insufficience and renal failure). Patients died from cardiopulmonary cause had a more frequent previous hospitalization (p < 0.04). Patients died from neurological cause had higher systolic and diastolic blood pressure at admission (p < 0.0001), higher rate of hypertension (p < 0.0001) and more frequent nosocomial fever (p = 0.0001). CONCLUSIONS: In our Service, male patients died with less age that women, the main death causes were cardiorespiratory diseases and subsequently neurologic diseases. Hypertension at admission was most frequent in patients died from neurologic cause.

Mortalidad hospitalaria en el Servicio de Medicina Interna de un hospital de primer nivel / Hospital mortality in the Internal Medicine Services of a first level center

Introducción: La mortalidad hospitalaria es un indicador de calidad asistencial y su estudio puede mejorar la asistencia de los pacientes hospitalizados. Nuestro objetivo fue conocer las causas de muerte más frecuentes en los pacientes hospitalizados, identificar variables clínicas y analíticas asociadas a cada causa y determinar diferencias según el género. Material y métodos: Se realizó una revisión sistemática y retrospectiva de 113 informes médicos de pacientes fallecidos, que correspondían al 26% de todos los fallecimientos ocurridos en el Servicio de Medicina Interna entre marzo de 2002 y noviembre de 2004. En cada caso se registraron variables epidemiológicas, historia clínica previa, parámetros bioquímicos y hematológicos, la causa de la muerte y complicaciones intrahospitalarias. Resultados: La edad media fue de 79 ± 10 años y el 58,4% de los casos correspondieron a varones. Tuvieron ingreso previo un 38% y el 45% se encontraba en una clase funcional III-IV. Los hombres fallecieron a una edad más temprana que las mujeres (76,6 ± 10,3 frente a 82,3 ± 8,0 p < 0,002) y con más frecuencia tuvieron antecedentes de enfermedad broncopulmonar crónica (43% frente a 19%, p < 0,04); sin embargo, las mujeres tuvieron peor situación ventilatoria al ingreso. Las principales causas de muerte fueron cardiopulmonares (56% en total, un 34% por insuficiencia respiratoria, 14% por neumonía y 8% por edema agudo de pulmón), seguidas de las causas neurológicas (25%, un 23% por ictus) y por un 19% de otras causas (neoplasia, fracaso multiorgánico, insuficiencia hepática e insuficiencia renal). Los fallecidos de causa cardiopulmonar habían tenido un ingreso previo con mayor frecuencia (p < 0,04). Los fallecidos por causa neurológica tenían al ingreso cifras más elevadas de tensión arterial sistólica y diastólica (p < 0,0001), mayor frecuencia de antecedentes de hipertensión arterial (p < 0,0001) y en mayor proporción fiebre nosocomial (p = 0,0001). Conclusión: En nuestro servicio, los hombres fallecen a edad más temprana que las mujeres y las principales causas de muerte son las enfermedades cardiopulmonares seguidas de las neurológicas. La hipertensión arterial se presenta al ingreso con mayor frecuencia en los fallecidos por causa neurológica

Background and objective: Hospital mortality is a indicator of quality of care, and their study may improve assistance of hospitalized patients. Our objective was to know the most frequent death causes of hospitalized patients, to identify clinical and analytical variables associated with each cause, and to determine gender differences. Material and methods: A sistematic and retrospective revision of 113 medical reports of death patients was carried out; it corresponded 26% of all deaths occurred between mars 2002 to november 2004. At each case, epidemiological variables, previous clinical reports, biochemical and haematological parameters, death cause and in-hospital complications were registered. Results: Mean age was 79 ± 10 years and 58.4% of cases were males. Thirty eight percent had previous admission, and 45% had functional class III-IV. Men died with less age that women (76.6 ± 10.3 versus 82.3 ± 8.0 p < 0.002) and they had more frequent antecedents of chronic bronchopulmonary disease (43% versus 19%, p <0.04); however, women had worse ventilatory situation at admission. The main death causes were cardiopulmonary (56% whole, 34% because of respiratory insufficience, 14% because of pneumonia, and 8% because of acute lung oedema), followed by neurological causes (25% whole, 23% because of stroke) and 19% because another reason (neoplasia, multiorganic failure, hepatic insufficience and renal failure). Patients died from cardiopulmonary cause had a more frequent previous hospitalization (p < 0.04). Patients died from neurological cause had higger systolic and diastolic blood pressure at admission (p < 0.0001), higger rate of hypertension (p < 0.0001) and more frequent nosocomial fever (p = 0.0001). Conclusions: In our Service, male patients died with less age that women, the main death causes were cardiorespiratory diseases and subsequently neurologic diseases. Hypertension at admission was most frequent in patients died from neurologic cause

[A new model for medical care to multi-admitted patients]. / Un nuevo modelo para la asistencia a los pacientes multiingresadores.

BACKGROUND AND OBJECTIVE: Patients with chronic conditions are often readmitted to hospital. A study was designed to improve health care to these patients. PATIENTS AND METHODS: Patients attended at the Internal Medicine Department of a hospital area who were admitted to hospital at least three times in a year were included in the study. Within a prospective study, patients were attended by means of specific consultation with care upon request and telephone care, with the possibility of programmed admission. RESULTS: Patients were followed for 32 months, with a 45% decrease in the admission rate, 50% in visits to the Emergency Department, and 26% in hospital stay days. CONCLUSIONS: The proposed care model decrease the attending needs for these patients.

Un nuevo modelo para la asistencia a los pacientes multiingresadores / A new model for medical care to multi-admitted patients

Fundamento. Los pacientes con patología crónica con gran frecuencia reingresan en el hospital. Se diseñó un estudio con el fin de mejorar su asistencia. Pacientes y métodos. Se incluyen los enfermos atendidos por el Servicio de Medicina Interna de un área hospitalaria que reingresaron tres o más veces en un año. Dentro de un estudio prospectivo se atendieron mediante una consulta específica con atención a demanda y atención telefónica, con la posibilidad de ingreso programado. Resultados. Los pacientes fueron seguidos durante 32 meses, con un descenso del 45 por ciento de los ingresos, del 50 por ciento en la frecuentación al Servicio de Urgencias y de un 26 por ciento de los días de estancia hospitalaria. Conclusiones. El modelo asistencial propuesto disminuye las necesidades asistenciales de estos pacientes. (AU)

[Bilateral avascular necrosis of the femur head in an HIV-positive male]. / Necrosis avascular bilateral de cabeza femoral en un varón VIH positivo.

We present a case of bilateral avascular necrosis at the hips of a HIV-positive male, without other predisposing antecedents. The only relevant analytic data was the positivity of anticardiolipin antibodies (aCL AB). We discuss the possibility that both in this case as in those previously described, HIV may have played a main role in the development of osteonecrosis.