ABSTRACT
OBJECTIVE: To know the clinical features of nursing home residents with pneumonia comparing with patients with Community-acquired pneumonia and identify the main prognostic index of mortality. MATERIAL AND METHODS: Longitudinal prospective study including all the elderly patients hospitalized in Cantoblanco Hospital of Madrid during the year 2001 for pneumonia and classified according to the Fine prognosis index and the SEPAR criteria. RESULTS: Of the 78 patients with pneumonia, 27 came from Residence, with an average of age of 86.85(+/- 6.43) years old, opposite to 83.11 (+/- 5.87) years in patients with Community acquired pneumonia ( p<0.05). Of all of them, 33,3% belonged to class IV and 66.7% to class V of Fine. Of all the variables studied, only the age (p= 0.03) and the hypoxemia (p= 0.03) were statistical significant. CONCLUSIONS: Nursing home residents with pneumonia are older and have more prevalence of morbi-mortality than those with Community acquired pneumonia. In our study, the age and the hypoxemia were the two independent prognosis factors associate to more mortality.
Subject(s)
Cross Infection/epidemiology , Pneumonia/epidemiology , Aged , Aged, 80 and over , Female , Homes for the Aged , Humans , Male , Nursing Homes , Pneumonia/classification , Prognosis , Prospective Studies , Referral and ConsultationABSTRACT
Objetivo: Conocer el perfil clínico de los pacientes con neumonía procedentes de Residencia comparándolo con los de neumonía adquirida en la comunidad (NAC) no institucionalizados e identificar los principales índices pronósticos de mortalidad. Material y métodos: Estudio prospectivo longitudinal de todos los ancianos ingresados en el Hospital de Cantoblanco de Madrid durante el año 2001 diagnosticados de neumonía y clasificados según el índice pronóstico de Fine y los criterios de la SEPAR. Resultados: De los 78 pacientes con neumonía, 27 procedían de Residencia, con una edad media de 86,85 (ñ 6,43) años, frente a 83,11 (ñ 5,87) años en los procedentes de domicilio (p<0,05). De ellos, el 33,3 por ciento pertenecían a la clase IV y el 66,7 por ciento a la clase V de Fine. De todas las variables estudiadas, sólo la edad (p= 0,03) y la hipoxemia (p= 0,01) fueron estadísticamente significativas. Conclusiones: Los pacientes con neumonía procedentes de Residencia tienen mayor edad y mayor prevalencia de morbi-mortalidad que los procedentes de su domicilio. En nuestro estudio, la edad y la hipoxemia son los dos factores pronósticos independientes asociados a mayor mortalidad (AU)
Subject(s)
Aged , Aged, 80 and over , Male , Female , Humans , Pneumonia , Nursing Homes , Prospective Studies , Prognosis , Referral and Consultation , Cross Infection , Homes for the AgedABSTRACT
Aportamos el caso de una mujer de edad avanzada con historia antigua de despeños diarreicos ocasionales no estudiada, que presentó un episodio de diarrea nosocomial secundaria a infección por Clostridium difficile. Se realizó una colonoscopia y biopsia ante la respuesta incompleta al tratamiento con vancomicina, siendo diagnosticada de colitis ulcerosa activa subyacente. La incidencia con la que el C.difficile se ha relacionado como desencadenate de un brote de colitis ulcerosa, se sitúa en torno al 10 per cent. Entre los pacientes con colitis ulcerosa es infrecuente encontrar los factores desencadenates clásicos de la infección por C. dif ficile: hospitalización reciente y/o uso previo de antibióticos; así como, tambien es inhabitual la visualización macroscópica de pseudomembranas. Parece existir una correlación directamente positiva entre el índice de actividad de la colitis ulcerosa y la frecuencia de la infección por C.difficile en estos pacientes. El tratamiento específico de la colitis pseudomembranosa, en la mayoría de los casos, es suficiente para controlar el brote de colitis ulcerosa, sin precisar potenciar el tratamiento de base (AU)
Subject(s)
Aged , Female , Humans , Vancomycin , Clostridioides difficile , Treatment Outcome , Recurrence , Anti-Bacterial Agents , Colonoscopy , Colitis, Ulcerative , Diarrhea , Enterocolitis, PseudomembranousABSTRACT
A case of nosocomial diarrhea by Clostridium difficile in an older woman with an old history of increasing stool frequency, is reported. Colonoscopy and biopsy was performed due to an incomplete response to vancomicyn, and the diagnosis of underlying ulcerative colitis was made. The incidence of Clostridium difficile infection associated with the relapse of ulcerative colitis is nearly 10%. In patients with ulcerative colitis, macroscopic pseudomembranes and the usual predisposing factors for Clostridium difficile infection, usually, are not present. It seems to exist a significant correlation between the severity of the relapse and Clostridium difficile. The specific treatment of the pseudomembranous colitis, in the majority of the cases, is sufficient for a correct control of relapse of ulcerative colitis.
Subject(s)
Clostridioides difficile/isolation & purification , Colitis, Ulcerative/microbiology , Enterocolitis, Pseudomembranous/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Colitis, Ulcerative/drug therapy , Colonoscopy , Diarrhea/microbiology , Diarrhea/therapy , Enterocolitis, Pseudomembranous/drug therapy , Female , Humans , Recurrence , Treatment Outcome , Vancomycin/therapeutic useABSTRACT
Granulomas in bone marrow are an infrequent finding related to diverse disease. We reviewed 8057 bone marrow studies made over a period of 10.5 years, confirming the presence of granulomas in 40 patients. Global incidence was 0.50% and annual incidence 3.80 cases/yr. Because of the non-specificity of the morphological data, the diagnostic significance of the finding is limited, but it does serve to narrow the field of etiological possibilities. Associated disease was demonstrated in 82.5%, infectious diseases being the most common (tuberculosis, brucellosis, typhoid fever and kala-azar). Two previously unpublished entities are introduced: refractory anemia with excess blast cells (dysmyelopoietic syndrome) and malignant histiocytosis. 3 patients presented human immunodeficiency virus infection, the etiopathogenic role of this retrovirus in the generation of granulomas being unknown. The efficacy of bone marrow study in demonstrating granulomas increases if both the aspirate clot and bone cylinder are examined.
