ABSTRACT
La enfermedad meningocócica se produce por la diseminación hematógena de Neisseria meningitidis. Hasta en un 20% de los casos se produce una sepsis meningocócica, meningitis en un 50% y en menor proporción otras afecciones como neumonía, artritis, uretritis, conjuntivitis o pericarditis, siendo los abscesos cerebrales una complicación excepcional (AU)
Meningococcal disease is caused by hematogenous spreading of Neisseria meningitidis. Meningococcal sepsis occurs in around 20% of cases of meningococcal disease, meningitis in 50% and, to a lesser extent, other conditions such as pneumonia, arthritis, urethritis, conjunctivitis or pericarditis. Brain abscesses are a rare complication (AU)
Subject(s)
Humans , Female , Adult , Brain Abscess/etiology , Bacteremia/complications , Meningococcal Infections/complications , Meningitis, Meningococcal/diagnosis , Fever/etiology , SyndromeABSTRACT
Meningococcal disease is caused by hematogenous spreading of Neisseria meningitidis. Meningococcal sepsis occurs in around 20% of cases of meningococcal disease, meningitis in 50% and, to a lesser extent, other conditions such as pneumonia, arthritis, urethritis, conjunctivitis or pericarditis. Brain abscesses are a rare complication.
Subject(s)
Bacteremia/complications , Brain Abscess/etiology , Fever/etiology , Meningococcal Infections/complications , Adult , Female , Humans , SyndromeABSTRACT
Thyrotoxic hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, characterized by attacks of generalized muscular weakness associated with hypokalemia in patients with hyperthyroidism, most frequently with Graves-Basedow disease. Treatment with antithyroid drugs and potassium supplements reversed the symptoms and the episodes of acute muscular weakness did not reappear.
Subject(s)
Hypokalemic Periodic Paralysis/etiology , Thyroid Crisis/complications , Humans , Male , Young AdultABSTRACT
La parálisis periódica hipopotasémica tirotóxica (PPT) es una rara complicación de la tirotoxicosis caracterizada por la aparición de episodios de debilidad muscular asociados a hipopotasemia en pacientes con hipertiroidismo, más frecuentemente con enfermedad de Graves-Basedow. El tratamiento con antitiroideos y suplementos de potasio revierte la sintomatología de debilidad muscular y evita la reaparición de estos síntomas (AU)
Thyrotoxic hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, characterized by attacks of generalized muscular weakness associated with hypokalemia in patients with hyperthyroidism, most frequently with Graves-Basedow disease. Treatment with antithyroid drugs and potassium supplements reversed the symptoms and the episodes of acute muscular weakness did not reappear (AU)
Subject(s)
Humans , Male , Adult , Hypokalemia/complications , Hypokalemia/diagnosis , Hypokalemia/drug therapy , Paralysis/complications , Paralysis/diagnosis , Thyrotoxicosis/complications , Thyrotoxicosis/diagnosis , Antithyroid Agents/therapeutic use , Thyroid Crisis/complications , Thyroid Crisis/drug therapy , Muscle Weakness/complications , Muscle Weakness/diagnosis , Potassium/therapeutic use , Potassium, Dietary/therapeutic use , Potassium Compounds/therapeutic useABSTRACT
Caso clínico: Se presenta el caso de una mujer de 18 años con un cuadro de diarrea, dolor abdominal y ptosis palpebral izquierda. La resonancia nuclear magnética cerebral (RMN) y el estudio del líquido cefalorraquídeo fueron normales. La colonoscopia estableció el diagnóstico de enfermedad de Crohn (EC) confirmándose en el estudio histopatológico. La afectación ocular mejoró tras el adecuado tratamiento de la EC. Discusión: La enfermedad inflamatoria intestinal (EII) se asocia a una amplia variedad de manifestaciones extraintestinales, de hecho puede ser considerada como una enfermedad sistémica que afecta predominantemente al tracto gastrointestinal. Las manifestaciones extraintestinales acontecen hasta en una tercera parte de los pacientes afectos de EII. Las complicaciones oculares son infrecuentes, afectando a menos del 10% de los casos, pero en ocasiones comportan una significativa morbilidad, incluyendo la ceguera. La sintomatología ocular puede preceder al diagnóstico de EII. Informamos el primer caso de ptosis palpebral asociado a EC (AU)
Clinical case: An 18 year-old-woman presented with abdominal pain, diarrhea, and ptosis in her left eye. Nuclear magnetic resonance imaging (NMRI) and the study of cerebrospinal fluid detected no abnormalities. Colonoscopy revealed a Crohn's disease (CD) confirmed by histological examination of biopsies. Ocular symptoms improved after appropriate treatment of the underlying CD. Discussion: Inflammatory bowel disease (IBD) is associated with a wide variety of extra-intestinal manifestations, in fact it may be considered a systemic disorder with predominantly gastrointestinal tract manifestations. Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but can be associated with significant morbidity, including blindness. Ocular symptoms may precede a diagnosis of IBD. We report the first case of palpebral ptosis associated with Crohn's disease (AU)
Subject(s)
Humans , Female , Adolescent , Blepharoptosis/etiology , Crohn Disease/complications , Risk Factors , Diagnosis, DifferentialABSTRACT
CLINICAL CASE: An 18 year-old-woman presented with abdominal pain, diarrhea, and ptosis in her left eye. Nuclear magnetic resonance imaging (NMRI) and the study of cerebrospinal fluid detected no abnormalities. Colonoscopy revealed a Crohn's disease (CD) confirmed by histological examination of biopsies. Ocular symptoms improved after appropriate treatment of the underlying CD. DISCUSSION: Inflammatory bowel disease (IBD) is associated with a wide variety of extra-intestinal manifestations, in fact it may be considered a systemic disorder with predominantly gastrointestinal tract manifestations. Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in one third of patients. Ocular complications are infrequent, occurring in less than 10% of cases, but can be associated with significant morbidity, including blindness. Ocular symptoms may precede a diagnosis of IBD. We report the first case of palpebral ptosis associated with Crohn's disease.
Subject(s)
Blepharoptosis/etiology , Crohn Disease/complications , Adolescent , Female , HumansABSTRACT
Las metástasis del leiomioma es una situación clínica excepcional, que habitualmente ocurre en mujeres, en el periodo (..) (AU)
Bening metastasizing leiomyoma is a rare condition that habitually affects (..) (AU)
Subject(s)
Humans , Female , Aged , Uterine Neoplasms/pathology , Leiomyoma/pathology , Lung Neoplasms/secondary , Neoplasm Metastasis/pathology , Hysterectomy , Radiography, ThoracicABSTRACT
AIMS: To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM). METHODS AND RESULTS: Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures. There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r(2) = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001). The global in-hospital mortality rate was 11.1% and we found differences between Cardiology and MI. MI patients were older (74 years compared to 69, p < 0.0001), had greater comorbidity, a similar length of stay (11.1 days), and a lower number of coded diagnostic procedures. Associated pathologies were different. Seasonal variation is clear. CONCLUSION: The incidence of discharges for heart failure is high and steadily increasing, although this is more evident in IM. The populations attended by the two services are different, which makes it difficult to ascertain differences in handling. The results are slightly different from those reported in other countries.
Subject(s)
Databases, Factual , Heart Failure/epidemiology , Hospital Records , Patient Discharge/statistics & numerical data , Aged , Cross-Sectional Studies , Female , Heart Failure/therapy , Humans , Male , Retrospective StudiesABSTRACT
Objetivos. Conocer la epidemiología de lahospitalización por insuficiencia cardiaca (IC) enlos hospitales de Andalucía (España). Definir elperfil de los pacientes asistidos en MedicinaInterna (MI).Métodos y resultados. Análisis del ConjuntoMínimo Básico de Datos (CMBD) de los 32hospitales públicos de Andalucía (España) durante1998-2002, identificando los casos con diagnósticoprincipal o secundario de IC analizando edad, sexo,estancia, estacionalidad, destino, número dediagnósticos, GDR, procedimientos codificados. Seprodujeron 2.787.008 altas, 27.248 de ICC,(15.737 MI, 7.735 Cardiología y 3.776 otrosservicios). Las altas por IC crecieron desde 1998 a2003 (r2 = 0,7232). El 44% fueron hombres conedad media de 70,98 años (IC 95% 70,08-70,47) yel 56% mujeres con 74,77 (IC 95% 74,61-74,93)(p<0,0001). La tasa de mortalidad intrahospitalariaglobal fue del 11,1% y encontramos diferenciasentre Cardiología y MI. Los pacientes queingresaron en MI tenían mayor edad (74 años frentea 69, p<0,0001), mayor comorbilidad, estanciamedia similar (11,1 días) y menor número deprocedimientos diagnósticos codificados. Lapatología asociada fue diferente. La estacionalidades evidente.Conclusión. La incidencia de IC es elevada yaumenta progresivamente, aunque más en MI.Las poblaciones de uno y otro servicio sondiferentes, por lo que es difícil asegurar diferenciasde manejo. Los resultados difieren ligeramente delos comunicados en otros países
Aims. To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM).Methods and results. Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures.There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r2 = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001).The global in-hospital mortality rate was 11.1% andwe found differences between Cardiology and MI.MI patients were older (74 years compared to 69,p < 0.0001), had greater comorbidity, a similarlength of stay (11.1 days), and a lower number ofcoded diagnostic procedures. Associated pathologieswere different. Seasonal variation is clear.Conclusion. The incidence of discharges for heartfailure is high and steadily increasing, although thisis more evident in IM. The populations attended bythe two services are different, which makes itdifficult to ascertain differences in handling. Theresults are slightly different from those reported inother countries
Subject(s)
Humans , Heart Failure/epidemiology , Hospitalization/statistics & numerical data , Medical Records Systems, Computerized/organization & administration , Databases as Topic/organization & administration , SeasonsABSTRACT
No disponible
Subject(s)
Humans , Hospitals, State/organization & administration , Day Care, Medical/statistics & numerical data , Internal Medicine/trends , Health Resources , Day Care, Medical/methods , Hospital StatisticsSubject(s)
Day Care, Medical , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Internal Medicine , Male , Middle AgedABSTRACT
OBJECTIVES: To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. METHOD: retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. RESULTS: We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%). We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 +/- 9 g/L vs. 63 +/- 8 g/L; p = 0.0231) and (22 +/- 7 g/L vs. 29 +/- 7 g/L; p = 0.0125) respectively. CONCLUSIONS: Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and don t follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infection s mortality is low and it s restricted to people with chronic illness, deep infections and bad nutritional status.
Subject(s)
Soft Tissue Infections/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Comorbidity , Female , Hospitals, Public/statistics & numerical data , Humans , Male , Middle Aged , Patient Admission , Retrospective Studies , Risk Factors , Soft Tissue Infections/diagnosis , Soft Tissue Infections/drug therapy , Spain/epidemiologyABSTRACT
Objetivos: Describir las características de los pacientes hospitalizados con infecciones de piel y partes blandas (IPPB) y analizar las variables de los que fallecen durante el ingreso para definir grupos de riesgo. Metodo: Análisis retrospectivo de las historias clínicas de todos los pacientes que fueron dados de alta con IPPB durante el año 2002, en los hospitales públicos de la provincia de Málaga. Se excluyen infecciones secundarias a pie diabético, cirugía, quemados, úlceras por decúbito y la celulitis orbitaria. Se analizaron variables clínicas, bioquímicas, indicación y validez diagnóstica de pruebas microbiológicas y de imagen, así como el tratamiento antibiótico empírico iniciado y su correlación con las recomendaciones terapéuticas establecidas. Resultados: Analizamos 391 ingresos de 374 pacientes. La celulitis fue el diagnóstico más frecuente (69,3%). Se realizaron pruebas de imagen en el 51,6% de los casos. El antibiótico más empleado fue la amoxicilina con ácido clavulánico (39%). Fallecieron 27 (6,7%), el 40,7% por el proceso séptico en sí. Todos los fallecidos, tenían algún tipo de enfermedad crónica asociada. Las únicas variables analíticas que se asociaron de forma significativa a mayor mortalidad fueron las proteínas totales (55 ± 9 g/L vs. 63 ± 8 g/L; p = 0,0231) y los concentraciones séricas de albúmina (22 ± 7 g/L vs. 29 ± 7 g/L; p = 0,0125). Conclusiones: Las celulitis es la IPPB que mayor número de ingresos genera en nuestro medio. Apreciamos una sobreutilización de pruebas de imagen y una desviación sobre las recomendaciones terapéuticas y el tratamiento aplicado en nuestros hospitales. La mortalidad global observada es baja y afecta de manera exclusiva a pacientes con mal estado nutricional al ingreso, enfermedades crónicas o infecciones profundas
Objectives: To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. Method: retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. Results: We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%).We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 ± 9 g/L vs. 63 ± 8 g/L; p = 0.0231) and (22 ± 7 g/L vs. 29 ± 7 g/L; p = 0.0125) respectively. Conclusions: Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and dont follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infections mortality is low and its restricted to people with chronic illness, deep infections and bad nutritional status
Subject(s)
Humans , Skin Diseases, Infectious/epidemiology , Soft Tissue Infections/epidemiology , Hospital Mortality/trends , Risk Factors , Retrospective Studies , Multicenter Studies as TopicABSTRACT
We present the case of a patient with an intracerebral hemorrhage as complication of an infectious endocarditis (EI) produced by Neisseria sicca on a prosthetic mitral valve. The patient was anticoagulated previously with Acenocumarol as prophylaxis of thrombosis of the prosthetic valve. He was diagnosed as having IE and later he presented neurological symptoms as consequence of several intracerebral hemorrhagic foci. We decided to continue the anticoagulation with sodium heparin followed of Bemiparina and no new hemorrhagic complications nor thrombosis of the valve were observed after three months of the event. We have not found in the literature any case where low molecular weight heparin has been used as method of anticoagulation in these cases beyond two weeks.
Subject(s)
Cerebral Hemorrhage/drug therapy , Endocarditis, Bacterial/complications , Heart Valve Prosthesis/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Mitral Valve , Neisseria sicca , Neisseriaceae Infections/complications , Prosthesis-Related Infections/complications , Cerebral Hemorrhage/etiology , Humans , Male , Middle AgedABSTRACT
Presentamos el caso de un paciente con una hemorragia intracerebral como complicación de una endocarditis infecciosa (EI) producida por Neisseria sicca sobre una válvula mitral metálica. El paciente estaba previamente anticoagulado con Acenocumarol como profilaxis de trombosis de la válvula protésica. Fue diagnosticado de EI y posteriormente presentó síntomas neurológicos como consecuencia de varios focos hemorrágicos intracerebrales. Se decidió continuar la anticoagulación con heparina sódica inicialmente y posteriormente con Bemiparina, no observándose nuevas complicaciones hemorrágicas ni trombosis de la válvula a los tres meses del evento. No hemos encontrado en la literatura ningún caso donde la heparina de bajo peso molecular (HBPM) haya sido utilizada como método de anticoagulación en estos casos más allá de dos semanas (AU)
