Síndrome de fatiga crónica. Mucho más que fatiga / Chronic fatigue syndrome: more than fatigue

El Síndrome de Fatiga Crónica (SFC) es una enfermedad reconocida por todas las organizaciones médicas internacionales y por la OMS, y está clasificada con el código G93.3 de la Clasificación Internacional de Enfermedades. Su prevalencia se estima en torno al 2,54 % siendo más frecuente en mujeres que en hombres (8/2) de edades comprendidas entre los 20 y los 40 años. Se define como una afección crónica de nueva descripción caracterizada por la presencia de sensación subjetiva de cansancio o agotamiento prolongado invalidante de más de seis meses de evolución que no se alivia con el descanso. Se trata de un síndrome multisistémico que presenta con frecuencia un número importante de fenómenos comórbidos. No se conocen hasta el momento pruebas específicas para confirmar el diagnóstico, ni tampoco existe un tratamiento curativo que solucione definitivamente este problema de salud. La evidencia más sólida se basa en el abordaje multidisciplinar para el tratamiento sintomático del dolor, los trastornos del sueño, la disfunción neurocognitiva-neurovegetativa y el control de la depresión y la ansiedad. La aportación específica de enfermería al cuidado de la persona que vive y convive con el SFC debe desarrollarse básicamente en el ámbito de la educación para la salud y los cuidados de soporte, apoyo y acompañamiento con el fin de ayudar a que el paciente y sus allegados encuentren una respuesta adaptativa a los cambios de salud(AU)

Chronic Fatigue Syndrome (CFS) is a disease recognized by all international medical organizations and WHO, and is classified under the code G93.3 of the International Classification of Diseases. Its prevalence is estimated around 2.54% being more common in women than in men (8/2) aged between 20 and 40. Is defined as a chronic new description characterized by the presence of subjective feeling of fatigue and exhaustion long disabling of more than 6 months duration that is not relieved by rest. It is a multisystem disorder that often presents a significant number of comorbid phenomena. Not known until specific tests to confirm the diagnosis, nor is there a cure to solve this health problem definitively. The strongest evidence is based on the multidisciplinary approach for the symptomatic treatment of pain, sleep disorders, neurocognitive dysfunction, autonomic and control of depression and anxiety. The specific contribution of nursing to care for the person who lives and live with the SFC should be developed primarily in the field of health education and supportive care, support and assistance to help the patient and their relatives are an adaptive response to changes in Elath(AU)

Manejo del paciente diagnosticado de síndrome de fatiga crónica / Nursing role in patient management diagnosed chronic fatigue syndrome

El síndrome de fatiga crónica es una enfermedad grave, compleja y debilitante caracterizada por una fatiga intensa, física y mental, que no remite de forma significativa tras el reposo y que empeora con la acción. La aparición de la enfermedad obliga al paciente a reducir la actividad deteriorando su calidad de vida. Si bien no existe un tratamiento curativo, la complejidad de la dolencia requiere un abordaje interdisciplinar donde la misión de enfermería consiste en identificar las respuestas menos saludables de cada individuo en relación a su situación de salud e interferir sobre ellas mediante intervenciones específicas de soporte, apoyo y acompañamiento integradas en un plan de cuidados adaptado a las necesidades individuales de cada persona. La fatiga, el dolor, la alteración del patrón del sueño, la ansiedad y el déficit de conocimientos son los problemas de salud más prevalentes en los pacientes asistidos en la Unidad de Fatiga Crónica del Hospital Universitario Vall d´Hebron. Así, ante estos problemas y mediante la elaboración de un plan de cuidados personalizado, utilizamos el proceso de educación para la salud como herramienta para actuar sobre el control de la sintomatología mediante intervenciones de soporte para favorecer el aprendizaje, y de apoyo emocional y de acompañamiento. Todo ello con el objetivo de ayudar a que el paciente y sus allegados encuentren una respuesta adaptativa a su nuevo estatus de salud y así poder mejorar su calidad de vida(AU)

Chronic fatigue syndrome is a serious, complex and debilitating fatigue characterized by intense physical and mental, that does not subside significantly after rest and worsens with activity. The appearance of the disease requires the patient to reduce the activity diminished their quality of life. While there is no cure, the complexity of the disease requires an interdisciplinary approach where the mission of nursing is to identify the least healthy responses of each individual in relation to their health status and interfering with them by means of specific support, integrated support and follow a care plan tailored to the individual needs of each individual. Fatigue, pain, sleep pattern disturbance, anxiety and lack of knowledge are the most prevalent health problems in patients treated at the Chronic Fatigue Unit, University Hospital Vall d'Hebron. Thus, in these problems and by developing a customized care plan process we use for Health Education as a tool for influencing the control of symptoms through interventions to improve the learning support, emotional support and Accompanying with the aim of helping the patient and their relatives are an adaptive response to their new health status and thus improve the quality of life(AU)

[Prevalence of atopy in chronic fatigue syndrome]. / Prevalencia de atopia en el síndrome de fatiga crónica.

BACKGROUND: Several hypotheses have been postulated to explain the etiopathogenesis of chronic fatigue syndrome (CFS). Among these, immunologic dysfunction has been proposed. Up to 30 % of these patients have a history of allergic disease. The aim of this study was to investigate whether allergic sensitization is higher in patients with CFS than in the general population. METHODS: Twenty-five patients with CFS and 20 controls were evaluated. A clinical history for allergy was taken and immediate hypersensitivity tests were performed. RESULTS: Twelve patients (48 %) and eight controls (40 %) had a family history of atopy. Personal histories of atopy were as follows: rhinoconjunctivitis: 12 patients (48 %), seven controls (35 %); asthma: five patients (20 %), two controls (10 %); food allergy: three patients (12 %); atopic dermatitis: two patients; contact dermatitis: two patients. No statistically significant differences were found between the groups in any of the variables (p > 0.05). In the CSF group, 3.4 % (15/441) of the inhalant prick tests were positive, and in the control group 3.8 % (16/420) were positive. None of the tests for hypersensitivity to food or latex were positive. CONCLUSIONS: In our study atopy was not more prevalent in patients with CFS than in healthy controls, although the CSF group tended to report more respiratory symptoms and drug allergies.

Prevalencia de atopia en el síndrome de fatiga crónica / Prevalence of atopy in chronic fatigue syndrome

Antecedentes: La etiología del síndrome de fatiga crónica (SFC) es desconocida habiéndose postulado varias hipótesis entre ellas la inmunológica. Se han descrito hasta en un 30 % de estos pacientes antecedentes de enfermedades alérgicas. El objetivo del estudio fue evaluar si la sensibilización alérgica es mayor en pacientes con SFC respecto a la población general. Pacientes y métodos: 25 pacientes diagnosticados de SFC y 20 voluntarios control fueron evaluados mediante una historia clínica y pruebas de hipersensibilidad inmediata. Resultados: Del total de pacientes evaluados 12 (48%) referían antecedentes familiares de atopia y en 8 de los controles (40%). Referían antecedentes personales de rinoconjuntivitis 7 controles (35%) y 12 pacientes (48%), asma 2 controles (10%) y 5 pacientes (20%), alergia alimentaria 3 pacientes (12%), dermatitis atópica 2 pacientes (8%) y dermatitis de contacto también 2 pacientes (8%). En ninguna de las variables se han observado diferencias estadísticamente significativas (p > 0,05). En las pruebas de hipersensibilidad inmediata a neumoalergenos se observaron 15/441 reacciones positivas (3,4%) en el grupo SFC y 16/420 (3,8%) en el grupo control. En las pruebas de hipersensibilidad a alimentos y látex no se observaron reacciones positivas. Conclusiones: La prevalencia de atopia en los pacientes con síndrome de fatiga crónica no es mayor que en la población general aunque se observa una mayor tendencia a referir síntomas respiratorios y reacciones adversas medicamentosas en el grupo con SFC

Background: Several hypotheses have been postulated to explain the etiopathogenesis of chronic fatigue syndrome (CFS). Among these, immunologic dysfunction has been proposed. Up to 30 % of these patients have a history of allergic disease. The aim of this study was to investigate whether allergic sensitization is higher in patients with CFS than in the general population. Methods: Twenty-five patients with CFS and 20 controls were evaluated. A clinical history for allergy was taken and immediate hypersensitivity tests were performed. Results: Twelve patients (48%) and eight controls (40%) had a family history of atopy. Personal histories of atopy were as follows: rhinoconjunctivitis: 12 patients (48%), seven controls (35%); asthma: five patients (20%), two controls (10%); food allergy: three patients (12%); atopic dermatitis: two patients; contact dermatitis: two patients. No statistically significant differences were found between the groups in any of the variables (p > 0.05). In the CSF group, 3.4% (15/441) of the inhalant prick tests were positive, and in the control group 3.8% (16/420) were positive. None of the tests for hypersensitivity to food or latex were positive. Conclusions: In our study atopy was not more prevalent in patients with CFS than in healthy controls, although the CSF group tended to report more respiratory symptoms and drug allergies

[A prospective study on patients with heart failure admitted to the internal medicine department]. / Estudio prospectivo de los enfermos ingresados por insuficiencia cardíaca en una sala de hospitalización de medicina interna.

CONTEXT: Heart failure (HF) is one of the most important causes of morbidity and mortality and represents one of the most frequent causes of rehospitalization. PATIENTS AND METHOD: Prospective study on patients admitted because of HF. A data collection questionnaire was completed: cardiology history, HF etiology, reason for admission, previous treatment, treatment during and after the admission, hospital stay and complementary explorations carried out. A biweekly telephone monitoring was carried out after the discharge. RESULTS: 62 patients admitted because of HF with an average age of 73 +/- 11 years. The etiology of the HF was: unknown (54%), hypertensive (21.5%), valvular (15.4%), ischemic (7.3%), alcohol (1.6%). All patients received diuretic treatment, 25% angiotensin-converting enzyme inhibitors (ACEI) and 6% oral anticoagulants. 51.6% showed atrial fibrillation. Echocardiogram was carried out in 10% of the patients. The average hospital stay was 6.2 +/- 3.2 days, and it was significantly higher when an echocardiogram was carried out (5.7 +/- 0.4 versus 7.55 +/- 0.9 days; p < 0.001). 6-month incidence of rehospitalization and mortality was 26% and 20% respectively. CONCLUSIONS: HF implied one fourth of admissions in a population of elderly patients with multiple conditions. The etiology of the HF was not established in more than half of the patients. A suboptimal utilization of the available treatments is demonstrated. HF is associated to a high incidence of rehospitalization and mortality.

A prospective, randomized, multicenter comparative study of clinafloxacin versus a ceftriaxone-based regimen in the treatment of hospitalized patients with community-acquired pneumonia.

In an open-label, phase 3, randomized, multicenter study, clinafloxacin (200 mg/d) was compared to ceftriaxone (2 g/d; with or without erythromycin) in 527 patients with acute community-acquired bacterial pneumonia (CAP). Primary efficacy parameters were clinical cure rate and microbiologic eradication rates (by pathogen and by patient) determined 5-9 d post-therapy (test of cure; TOC). Clinical cure rates at TOC for the 2 treatment groups were equivalent in the intention-to-treat (clinafloxacin 79.3, ceftriaxone 78.6%), clinically evaluable (clinafloxacin 88.1, ceftriaxone 85.0%), modified intention-to-treat (clinafloxacin 82.6, ceftriaxone 86.9%) and microbiologically evaluable populations (clinafloxacin 86.2, ceftriaxone 86.2%). Microbiologic eradication rates were similar in the 2 treatment groups. Both drugs were tolerated. Treatment of hospitalized CAP patients with clinafloxacin is a reasonable choice, especially when a resistant pathogen is anticipated.

[Analysis of factors associated with anticoagulant treatment indication in chronic atrial fibrillation. Prospective study of 170 patients admitted at an internal medicine service]. / Análisis de los factores asociados a la indicación de tratamiento anticoagulante en la fibrilación auricular crónica. Estudio prospectivo de 170 pacientes ingresados en un servicio de Medicina Interna.

BACKGROUND: Anticoagulant therapy reduces the risk of stroke among patients with chronic atrial fibrillation. The objective of this study was to evaluate the use of anticoagulant therapy and to analyze the factors associated with the indication of anticoagulants in patients with chronic atrial fibrillation. PATIENTS AND METHODS: Prospective study of all patients with chronic atrial fibrillation admitted to our Department of Internal Medicine from February 1997 to September 1998. From each patient data related to the cause of atrial fibrillation, other associated vascular risk factors, use of anticoagulant and/or antiplatelet agents and contraindication to anticoagulants were recorded. RESULTS: A total of 170 patients with chronic atrial fibrillation were studied. The mean age of patients was 77 years (range: 49-94). One hundred and four patients (61%) were older than 75 years. Atrial fibrillation was the main cause for admission only in 11 patients (6.5%). One hundred and sixty-seven patients (98%) had indication for receiving anticoagulant therapy; however, it was indicated in only 67 patients (39%). In other 68 patients (40%), antiplatelet agents were used. Patients over 75 years received anticoagulants less frequently (p < 0.0001). Factors associated with the prescription of anticoagulants in the bivariate analysis included: diabetes mellitus (p = 0.046), high cholesterol level (p = 0.023), age < or = 75 years old (p < 0.0001), history of previous embolic events (p = 0.001) and valvular atrial fibrillation (p < 0.0001). The multivariate analysis showed that only two factors were indeed associated with the prescription of anticoagulants: age < or = 75 years (OR: 6.15) and valvular atrial fibrillation (OR: 4.24). CONCLUSIONS: Anticoagulant therapy is underused in patients with chronic atrial fibrillation, particularly in elderly patients.

[Varicella pneumonia in the adult. A review of 25 cases]. / Neumonía varicelosa en el adulto. Revisión de 25 casos.

OBJECTIVE: To study the clinical, therapeutic, and evolutive features in 25 patients with the diagnosis of varicella pneumonia (VP) in the last 15 years. PATIENTS AND METHODS: The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of smoking habit, pregnancy, and underlying disease were evaluated. Hypoxemia was defined as a pO2 < or = 65 mmHg with a FiO2 of 0.21. RESULTS: Twenty-five patients (16 males and 9 women; mean age 31.5 years, range: 24-43 years) were included in the study. Ninety-two percent of patients were smokers of more than 20 cigarettes a day; five met criteria of simple chronic bronchitis, 3 were known carriers of human immunodeficiency virus (HIV) and one had a chronic liver disease caused by hepatitis C virus. In 16 patients (64%) there were no underlying diseases and none of the female patients was pregnant. Respiratory symptoms began from the first and seventh day after the skin rash, and the most common symptoms were cough (76%), dyspnea (48%), and chest pain (44%). In 22 patients an arterial gas determination was obtained and hypoxemia was documented in 8 patients (32%). Hypoxemia was greater and statistically significant in patients with underlying diseases (p < 0.01). Chest X-ray revealed an interstitial pattern predominantly at both bases. Intravenous acyclovir therapy was started in 19 patients (76%) with severe respiratory symptoms and/or underlying disease. Three patients (12%) were admitted to the Intensive Care Unit for mechanical ventilation. All patients had a favourable clinical course. CONCLUSIONS: Adult patients with symptoms of VP had a favourable clinical course with intravenous acyclovir, and the presence of hypoxemia was more commonly observed when underlying diseases were also present.

[Varicella pneumonia in adults. Study of 13 cases]. / Neumonía varicelosa en el adulto. Estudio de trece casos.

Clinical and therapeutic features of 13 adult patients, diagnosed of Pneumonia Varicellosa are retrospectively reviewed, for the last ten years period, at Valle de Hebron General Hospital, Barcelona. Most of them had a cigarette consumption of over 20 per day, three of them showed simple chronic bronchitis criteria, and two had antibodies against HIV. Respiratory symptomatology, and dry cough, was present in 9 (75%), dyspnea in 7 (53%) and pleuritic pain in 6 (46%). Thorax radiology showed a bilateral interstitial pattern. IV aciclovir treatment was begun in patients with respiratory symptoms and hypoxemia (53%) with good therapeutic response.

Three cases of idiopathic bronchiolitis obliterans with organizing pneumonia.

Three patients with bronchiolitis obliterans organizing pneumonia are described. Chest X-ray films showed peripheral densities and pulmonary function tests a restrictive pattern. In all three cases transbronchial biopsy was not useful for diagnosis and we point out the importance of an open lung biopsy in order to make the differential diagnosis with other infiltrative lung disease with a different prognosis and therapy.