ABSTRACT
Antecedentes: los médicos se enfrentan a aspectos éticos en su práctica clínica que producen perplejidad, exigen mucho tiempo y les implican emocionalmente. No sólo la vertiente clínica influye en la decisión, sino que interactúan otros factores como las creencias religiosas derivadas de la doctrina católica, en nuestro caso, y los aspectos legales. Las convicciones religiosas influyen en la forma de ver la vida y la muerte. Algunas familias, basándose en la creencia de que la doctrina católica apoya la hidratación hasta el final de la vida, demandan el mantenimiento de la misma a pesar de que ello puede prolongar el sufrimiento de su familiar agónico. Los aspectos legales de la cuestión preocupan sobre todo en relación a la problemática del encarnizamiento terapéutico, que puede derivarse del temor del personal sanitario a hipotéticas demandas legales. Todo ello plantea una disyuntiva. Este trabajo surge como una reflexión acerca del dilema ético planteado a los sanitarios en la toma de decisiones sobre la práctica de la hidratación en la sedación paliativa en agonía. Objetivo: revisar la literatura especializada relacionada con aspectos clínicos, antropológicos, doctrinales de la Iglesia Católica y médico-legales, según la legislación española e internacional, sobre la hidratación en el contexto de la sedación paliativa en la agonía. Material y método: una revisión narrativa de la literatura utilizando el buscador general Google y la base de datos Pubmed. Capítulos de libros sobre temas de medicina paliativa, antropología y legislación, los números anteriores de Medicina Paliativa y documentos tanto de la Sociedad Española de Cuidados Paliativos (SECPAL) como de la Iglesia Católica. La revisión se hizo en los idiomas español e inglés. Se seleccionaron aquellos artículos en los que la hidratación y/o la sedación paliativa en la agonía se trataban de manera relevante o aportaban algún dato significativo al tema. Resultados: se seleccionaron 8 capítulos de 7 libros de texto, 10 artículos, 11 documentos, compendios de legislación, 1 Acta del Senado, 1 sentencia judicial y 1 artículo de un periódico de información general. Se eligieron por sus referencias a la valoración de aspectos: a) clínico-antropológicos; b) doctrinales católicos; y c) médico-legales respecto a la hidratación en los últimos días de vida, con especial énfasis en las consideraciones éticas de cada apartado. Conclusión: desde el punto de vista clínico existe controversia sobre la hidratación en la agonía, siendo necesario individualizar cada situación y conjugarla con las creencias, actitudes y valores del paciente y su familia. Aunque la doctrina católica propugna la hidratación y la nutrición como cuidados debidos a todos los enfermos, considera lícito suprimirlas o no iniciarlas si resultan gravosas para el paciente. Desde el punto de vista legal, la hidratación parenteral en la agonía es opcional, siendo aconsejable razonar el proceso de toma de decisiones en la historia clínica
Background: physicians have to face ethical issues in their clinical practice that may induce perplexity, be time-consuming, and emotionally involve them. Not only clinical aspects influence decision making, but also other factors like religious beliefs (in our setting, mainly the Catholic point of view) or even Legal regulations. The way of perceiving life and death is influenced by religious faith; some families request hydration for their terminally ill relatives, even though this may lengthen their suffering. That is because they believe that Catholic doctrine endorses hydration to the end of life. The legal aspects of these questions derive from the fear of healthcare professionals to hypothetic claims, which could drive them to therapeutic obstinacy. This paper attempts to reflect on the ethical dilemma that we often face up in palliative care regarding decision making on sedation and hydration for terminally-ill patients. Objective: a review of the specialized literature related to clinical, anthropological, Catholic Church, and medico-legal aspects (domestic and international legislation) concerning hydration in the context of palliative sedation at the end of life. Material and method: a narrative review of the literature using Google and the Pubmed database. Book chapters on palliative medicine, anthropology and legislation, former issues of Medicina Paliativa, and documents from not only Sociedad Española de Cuidados Paliativos (SECPAL), but also the Catholic Church. The review was carried out in both Spanish and English. Papers dealing with hydration and/or palliative sedation at the end of life, or providing any significant information thereupon, were selected. Results: eight chapters from 7 textbooks, 10 articles, 11 documents and legislation compendia, 1 Senate committee decision, 1 judicial sentence, and 1 general newspapers opinion article were selected. They were chosen because of their references to clinical-anthropological, Catholic doctrinal, and medical-legal aspects about hydratation at the end of life, with special emphasis in the ethical regards of each source. Conclusion: from a clinical point of view there is controversy about hydration at the end of life, and decisions should be made on an individual basis considering patient and family attitudes and values. While the Catholic doctrine endorses hydration and nutrition for all patients, it also allows their discontinuation or absence should these measures be ultimately grievous. From a legal point of view, artificial hydration at the end of life is optional, but the rationale of a decision for or against it should be included in the patients medical record
Subject(s)
Humans , Religion , Palliative Care/ethics , Professional-Family Relations/ethics , Palliative Care , Decision Making/ethics , Pain/drug therapyABSTRACT
Objetivo: Conocer los factores pronósticos de mortalidad hospitalaria en los pacientes ancianos y pluripatológicos ingresados en nuestro Hospital de Asistencia a Crónicos de Media y Larga Estancia. Método: Se realiza una valoración multidimensional de forma longitudinal y prospectiva a 117 pacientes mayores de 75 años, tanto al ingreso como al alta o fallecimiento y se le aplica un tratamiento estadístico (Modelo de Regresión Logística). Resultado: Se aprecia un predominio significativo de mujeres sobre hombres, una elevada prevalencia de deterioro neurológico, y especialmente un alto porcentaje de pacientes que ingresaba con dos o más factores de riesgo. Comprobamos como el deterioro cognitivo, la situación funcional y los niveles bajos de albúmina, se asocian significativamente con una mayor mortalidad. Conclusiones: La evaluación de estas variables es fundamental para emitir un pronóstico y en ocasiones, para mejorarlo. Nuestros resultados, en líneas generales, son similares a la literatura revisada
Objective: To know the prognostic factors for hospitalary mortality in elderly patients with co-occuring diseases in our medium-long-term and chronic care Hospital (MLT&CCH). Method: We performed longitudinally and prospectively a multiple assessment to 117 patients aged 75 or older. This assessment was made at inclusion and discharge or die, and data were studied by statistical analysis (Logistic Regression Model). Results: The prevalence of women over men was significative. We also detected a high prevalence of neurologic impairment, but mainly the high percentage of admitted patients with two or more risk factors. We appreciate that cognitive dilapidation, social disability and low levels of albumine were significantly associated with higher mortality. Conclusions: The evaluation of these variables is fundamental to emit a prognosis and some times to improve it. Our results mainly concur with previous reports in literature
Subject(s)
Male , Female , Middle Aged , Humans , Prognosis , Hospital Mortality/trends , Risk Factors , Comorbidity , Functional Residual Capacity/physiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnosis , Logistic Models , Mortality/statistics & numerical data , Prospective Studies , Longitudinal Studies , Logistic ModelsABSTRACT
OBJECTIVE: The patient orientation clinic (POC), acting as a filter, is an initiative aimed at reducing the waiting lists for medical specialities. METHODS: For a six-months period, an internist and a registered nurse attended 1,265 patients proposed for those specialties. RESULTS: 85.7% of cases were referred to their general practitioners after evaluation at our clinic. The remaining patients (14.3%) went on and frecuently benefited from initial therapies or because complementary tests and/or examinations were arranged for and earlier date. CONCLUSIONS: POC is shaping as a promising tool for health resource management in reducing waiting lists in medical specialties.
Subject(s)
Medicine/organization & administration , Patient Care Management/organization & administration , Referral and Consultation , Specialization , Waiting Lists , Adult , Female , Humans , Male , Middle Aged , SpainABSTRACT
Objetivo. La consulta de orientación de pacientes (COP) es una iniciativa encaminada a disminuir las listas de espera para especialidades médicas, actuando como filtro. Métodos. Un internista y un enfermero atendieron durante seis meses a 1.265 pacientes propuestos para dichas consultas. Resultados. El 85,7 por ciento de los casos fueron remitidos a su médico de cabecera tras haber sido valorados en nuestra consulta. El 14,3 por ciento restante siguió su curso, si bien habiéndose beneficiado frecuentemente de tratamientos iniciales o del adelanto de pruebas complementarias. Conclusiones. La COP se perfila como una medida de gestión sanitaria prometedora para reducir listas de espera en especialidades médicas (AU)
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Waiting Lists , Referral and Consultation , Spain , Medicine , Patient Care ManagementABSTRACT
No disponible
Subject(s)
Aged , Female , Male , Middle Aged , Humans , Staphylococcus epidermidis/pathogenicity , Staphylococcal Infections/etiology , Bacteremia/etiology , Staphylococcus epidermidis/isolation & purification , Staphylococcus epidermidis , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Novobiocin/pharmacology , Urinary Tract Infections/etiology , Urinary Tract Infections/diagnosis , Conjunctivitis/diagnosis , Conjunctivitis/etiology , Bacteremia/diagnosis , Bacteremia/drug therapyABSTRACT
We present the case of a 33 year old man who consulted because a lumbago; a bone lesion was detected on a lumbosacral radiography, and finally was diagnosed of Multiple Myeloma. The illness, diagnosis and epidemiology are briefly analyzed, rebounding the rarity of its presentation in a young man.
Subject(s)
Low Back Pain/etiology , Multiple Myeloma/diagnosis , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carmustine/therapeutic use , Combined Modality Therapy , Doxorubicin/therapeutic use , Humans , Leg , Low Back Pain/diagnosis , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Male , Multiple Myeloma/drug therapy , Multiple Myeloma/radiotherapy , Prednisone/therapeutic use , Radiography , Treatment Outcome , Vincristine/therapeutic useABSTRACT
Staphylococci are frequently isolated from human, animal and environmental samples. The genus Staphylococcus comprises 27 species, of which 23 are coagulase-negative. The pathogenic role of the coagulase-negative species remains to be fully established. Staphylococcus lugdunensis is a recently described coagulase-negative species. Its Latin name reflects the city (Lyon, France) where the bacteria was first described. The present study reports 7 cases of human infection caused by S. lugdunensis. Case 1: a 64 y/o diabetic woman in whom S. lugdunensis was isolated in the conjunctival exudate. Case 2: a 51 y/o male diagnosed of a bladder tumor, with S. lugdunensis detected in the purulent exudate of a transurethral resection. Case 3: an 81 y/o woman with cerebrovascular stroke, in whom S. lugdunensis was isolated from urine. Case 4: a 65 y/o male with bacterial endocarditis and S. lugdunensis isolation in blood culture. Case 5: a 79 y/o male with liver cirrhosis and S. lugdunensis in blood culture. Case 6: a 75 y/o female with cerebrovascular stroke, in whom S. lugdunensis was isolated from urine. Case 7: a 77 y/o male diagnosed of femoral osteosarcoma and isolation of S. lugdunensis in the purulent exudate of the wound. The present communication broadens the range of clinical syndromes in which coagulase-negative S. lugdunensis appears as pathogen.
Subject(s)
Staphylococcal Infections/microbiology , Staphylococcus/isolation & purification , Aged , Coagulase/deficiency , Female , Humans , Male , Middle Aged , Staphylococcal Infections/diagnosis , Staphylococcus/enzymologyABSTRACT
Se presenta el caso de un varón de 33 años que consulta por lumbalgia y a quien se detecta una lesión ósea en la radiografía lumbosacra, siendo finalmente diagnosticado de Mieloma Múltiple. Se comenta brevemente la enfermedad, su diagnóstico y su epidemiología, subrayando la rareza de su presentación en un joven (AU)
Subject(s)
Adult , Male , Humans , Carmustine/therapeutic use , Combined Modality Therapy , Leg , Low Back Pain/diagnosis , Lumbar Vertebrae , Magnetic Resonance Imaging , Multiple Myeloma/drug therapy , Multiple Myeloma/radiotherapy , Prednisone/therapeutic use , Treatment Outcome , Vincristine/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Doxorubicin/therapeutic use , Low Back Pain/etiology , Multiple Myeloma/diagnosisABSTRACT
Los estafilococos se aislan frecuentemente en muestras humanas, animales y del medio ambiente. Existen 27 especies dentro del género Staphylococcus, de ellas, 23 son coagulasa negativas. El papel patógeno de las especies coagulasa negativas no está todavía bien asentado. Staphylococcus lugdunensts es una especie coagulasa negativa descrita recientemente. Su nombre viene del latín lugdunum, que significa Lyon, por haber sido en esta ciudad donde se describió por primera vez. El objeto de la presente comunicacion es describir 7 casos humanos de infección por esta bacteria. Caso 1: paciente diabetica de 64 años en la que se aisló S. lugdunensis en el exudado conjuntival. Caso 2: paciente varón de 51 años diagnosticado de neoformación vesical, aislando S. lugdunensis en el exudado purulento de una resección transuretral. Caso 3: paciente de 81 años diagnosticada de accidente cerebrovascular isquémico, con S. lugdunensis aislado en orina. Caso 4: paciente de 65 años diagnosticado de endocarditis bacteriana, aislándose S. lugdunensis en hemocultivo. Caso 5: paciente de 79 años con cirrosis hepática y aislamiento de S. lugdunensis en hemocultivo. Caso 6: paciente de 75 años diagnosticada de accidente cerebrovascular, aislando S. lugdunensis en orina. Caso 7: varón de 77 años con osteosarcoma de fémur y aislamiento de S. lugdunensis en el exudado purulento de la herida. La presente comunicación expande los síndromes clínicos en los que S. lugdunensis, estafilococo coagulasa negativo, aparece como bacteria patógena (AU)
Subject(s)
Aged , Female , Male , Middle Aged , Humans , Coagulase/deficiency , Staphylococcal Infections/diagnosis , Staphylococcus/enzymology , Staphylococcal Infections/microbiology , Staphylococcus/isolation & purificationABSTRACT
Urinary infections caused by Staphylococcus are attributed usually to Staphylococcus epidermidis or Staphylococcus saprophyticus. 8 cases of urinary infection due to S. haemolyticus are discussed: 5 adults all of them over 66 years, diagnosed respectively of diabetes, cancer and stroke. Three children diagnosed of febrile syndrome, encephalopathy and enterocolitis associated with urinary infection. S. haemolyticus was identified through the determination of 19 biochemical parameters. The antibiograms performed showed that all S. haemolyticus isolated were sensible to vancomycin, nitrofurantoin and trimethoprim/sulfamethoxazole. It is concluded that S. haemolyticus is an opportunistic pathogen that is present on immunodepressed hosts, that is why is advisable to perform a more in-depth characterization of the S. epidermidis isolated in urine, especially in persistent pathologic processes.
Subject(s)
Opportunistic Infections/microbiology , Staphylococcal Infections/microbiology , Staphylococcus/isolation & purification , Urinary Tract Infections/microbiology , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacteriuria/complications , Bacteriuria/microbiology , Female , Humans , Infant , Male , Microbial Sensitivity Tests , Opportunistic Infections/complications , Staphylococcal Infections/complications , Staphylococcus/drug effects , Urinary Tract Infections/complicationsABSTRACT
A clinical case of a 58 year old male suffering from hepatitis non A, non B, and terminal chronic renal insufficiency under periodic dialysis, is presented. Following a 600 cc of packed red blood cells transfusion, there was an increase of antibodies IgG against cytomegalovirus (from 1/160 to 1/1560), detected by ELISA. At the same time, there were an increase of transaminases up to 404 UI/ml of GPT. Total bilirubin persisted normal. The possible etiology of the hepatitis non A, non B caused by cytomegalovirus is discussed and the results compared to those observed by other authors in immunosuppressed renal transplant patients.
Subject(s)
Cytomegalovirus Infections/complications , Hepatitis C/complications , Humans , Male , Middle AgedABSTRACT
We study 18 children with acute respiratory infection diagnosed early by direct immunofluorescence (DIF) using monoclonal antibodies to synticial respiratory virus (SRV). Antibodies to adenovirus, influenza virus A and B, parainfluenza virus 1, 2 and 3, mycoplasma, Q fever, herpes and cytomegalovirus (CMV) are also studied. We consider that in most cases the diagnosis of infections caused by SRV cannot be established by complement fixation, and should be accompanied by some antigen detection technique. Direct immunofluorescence facilitates the early detection of SRV in most cases before the appearance of antibodies to this virus. Only one of the 18 patients with positive DIF presented antibodies to SRV.
Subject(s)
Respiratory Syncytial Viruses/immunology , Respirovirus Infections/diagnosis , Antibodies, Monoclonal/immunology , Fluorescent Antibody Technique , Humans , Infant , Infant, Newborn , Respirovirus Infections/immunologyABSTRACT
Nine cases of respiratory infections caused by syncytial respiratory virus which were diagnosed by direct immunofluorescence with monoclonal antibodies are presented here. Six of them have been clinically diagnosed as bronchiolitis and the remaining three are diagnosed as obstructive bronchitis, upper respiratory cold and respiratory distress respectively. Seven are male and two are female. Their ages vary from 13 days to eleven months. Its usefulness is indicated given its speed and the current availability of specific antiviral therapeutics. The test would be especially indicated in atypical cases like nursing babies with apnea or those with congenital heart disease or other underlying lung diseases and also to prevent intrahospital epidemias. The conclusion is reached that direct immunofluorescence seems to be an attractive alternative for laboratories that do not have costly cell culture equipment.