Norton scale score on admission and mortality of patients hospitalised in Internal Medicine departments. / Puntuación de la escala de Norton al ingreso y mortalidad en pacientes hospitalizados en Medicina Interna.

OBJECTIVE: To determine the association between the Norton scale score (which assesses the risk of pressure ulcers) and mortality in the short, medium and long term in patients hospitalised in Internal Medicine departments. PATIENTS AND METHODS: A prospective, single-centre cohort study was conducted on patients hospitalised in the months of October 2010 and January, May and October 2011. Data was collected on age, sex, Barthel index, Norton scale, presence of pressure ulcers, major diagnostic category, hospital stay and weight of the diagnosis-related group. The patients were divided according to the risk categories of the Norton scale. The follow-up was 3 years. RESULTS: The study included 624 patients with a median age (interquartile range) of 79 (17) years and a median Norton scale score of 16 (7). During hospitalisation, 74 (11.9%) patients died, 176 (28.2%) died at 6 months, 212 (34.0%) died at 1 year, and 296 (47.4%) died at 3 years. Mortality was greater in the higher risk categories of the Norton scale. The Norton score was independently associated with mortality at 6 months (p<.001), at 1 year (p=.005), and at 3 years (p=.002). The areas under the curve of the Norton scale were 0.746 (95% CI 0.686-0.806), 0.735 (95% CI 0.691-0.780) and 0.751 (95% CI 0.713-0.789), respectively (p<.001). CONCLUSIONS: The Norton scale is useful for predicting the prognosis in the short, medium and long term in patients hospitalized in internal medicine departments.

Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality. / Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad.

OBJECTIVE: To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. PATIENTS AND METHODS: Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. RESULTS: The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). CONCLUSIONS: Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality.

[Stroke as the first manifestation of a concealed pancreatic neoplasia]. / Ictus como primera manifestación de una neoplasia pancreática oculta.

INTRODUCTION: Stroke is very seldom seen as the first manifestation of a neoplasia. The mechanisms that are most frequently involved in its pathogenesis are Trousseau's syndrome, haematological disorders such as disseminated intravascular coagulation or thrombocytosis, and the release of mucin by the tumour. Secondarily, non bacterial thrombotic endocarditis, septic or neoplastic cell embolism, venous sinus thrombosis and atherosclerosis secondary to radiotherapy have been reported. CASE REPORTS: Case 1: a 27-year-old male who presented a stroke in the right thalamus with a torpid progression and digestive complications; neuroimaging studies revealed unknown neoplasia of the head of the pancreas. Case 2: a 53-year-old male with repeated stroke (left sylvian and right occipitotemporal) and progressive neurological deterioration secondary to disseminated neoplastic disease, which had its origins in the body and tail of the pancreas. In both cases all the diagnostic explorations carried out in an attempt to determine the aetiopathogenesis of the stroke were negative. The post mortem study in the second patient revealed the existence of a non bacterial thrombotic endocarditis, which was taken as being one of the mechanisms involved. CONCLUSIONS: The pathogenic mechanisms of cerebral ischemia associated to neoplasia are discussed and the primary and secondary forms are differentiated. We highlight the idea that when dealing with a stroke with an unknown aetiology and a torpid progression, the neurologist must consider the existence of a concealed neoplasia with stroke as its first manifestation.