Utility intervention programs in the evolutional control of patients with heart failure / Utilidad de los programas de intervención en el control evolutivo de los pacientes con insuficiencia cardiaca.

Acute heart failure (HF) is a prevalent disease with important socio-economic repercussions. Due to the aging of population, these values will increase in the coming years, so it may be useful to the implementation of intervention programs in these patients to decrease morbidity and mortality. A quasi-experimental prospective study (n = 262) of patients admitted at the Internal Medicine Department of the Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain, diagnosed of HF between November 2013 and October 2014 (both dates inclusive) (n = 108) followed up for 1 year was performed. Within this group, a subgroup with an intensive intervention (n = 30) was performed. The data were compared with a historical cohort of patients admitted to the same department during the same time in the previous year (from November 2012 to October 2013) (n = 154). Statistically significant differences between groups attending to the therapeutical adherence to clinical guidelines (p < 0.011) were observed. Considering the intensive intervention subgroup, statistically significant differences were observed in the rate of exitus (p < 0.032) and survival (log rank <0.030) compared to the control group. The close monitoring of patients with HF improves adherence, reduces mortality and improves survival. This May result in a decline in the use of health resources, which entails significant socio-economic benefits.

Disección aneurismática del tronco celíaco, una entidad infrecuente / Isolated celiac trunk aneurysm dissection: A rare entity / Dissecção aneurismática do tronco celíaco, uma entidade infrequente

RESUMEN La disección aislada y espontánea de la arteria celíaca es una entidad clínica rara. Es la cuarta causa de aneurismas abdominales por detrás de los que ocurren en las arterias esplénica, hepática y mesentérica superior. Es importante sospechar el diagnóstico de esta enfermedad cuyos síntomas son inespecíficos. Presentamos el caso de un varón de 60 años de edad atendido en nuestro hospital por esta enfermedad, y hacemos una revisión del tema con énfasis en el diagnóstico y en los diferentes tratamientos disponibles.

SUMMARY Spontaneous and isolated celiac artery dissection is a rare clinical disease. It is the fourth cause of abdominal aneurysms behind those that occur in the splenic, hepatic, and superior mesenteric arteries. It is important to suspect the diagnosis of this entity whose clinical symptoms are unspecific. We report the case of a 60 year-old male treated in our hospital because of this illness, and present a review of this pathology, specially focused on the diagnosis and the different treatments available.

RESUMO A dissecção isolada e espontânea da artéria celíaca é uma entidade clínica rara. É a quarta causa de aneurismas abdominais por detrás dos que ocorrem nas artérias esplénica, hepática e mesentérica superior. É importante suspeitar o diagnóstico desta doença cujos sintomas são inespecíficos. Apresentamos o caso de um homem de 60 anos de idade atendido no nosso hospital por esta doença, e fazemos uma revisão do assunto com ênfase no diagnóstico e nos diferentes tratamentos disponíveis.

Propeptide of procollagen type I (PIP) and outcomes in decompensated heart failure.

BACKGROUND: Changes in extracellular matrix are recognized as a contributing factor in the cardiac remodeling process. Several studies have addressed the value of turnover markers of collagen as predictors of death or new heart failure episodes. The aim of the present study was to evaluate the relationship between peripheral serum concentration of propeptide of procollagen type I (PIP) and outcomes in patients with decompensated heart failure. METHODS: A total of 111 patients admitted to our Unit between September 2000 and May 2003 for decompensated heart failure were analyzed. Death from any cause or due to heart failure and readmission were considered primary endpoints. RESULTS: The mean PIP concentration was 80.84+/-36.40 ng/mL. The PIP serum level was significantly higher among those patients who suffered some endpoint during follow-up (88.12+/-37.31 ng/mL vs 73.13+/-34.06 ng/mL; p=0.029). Twenty-five (22.52%) of the 111 patients died during the 21 months of follow-up, and 54 (48.6%) were readmitted with new bouts of heart failure. Using Cox proportional hazards regression analyses, serum PIP levels, systolic dysfunction, and diabetes mellitus were identified as independent predictors of death. Serum PIP levels, age, and sex were independent predictors of new heart failure episodes and readmission. CONCLUSION: A single serum measurement of PIP seems to have prognostic value in patients with decompensated heart failure. Accordingly, patients with higher values of PIP at decompensation are at a higher risk of death or readmission during follow-up.

Intoxicación por carbamazepina en un paciente con infección por el virus de la inmunodeficiencia humana en tratamiento antirretroviral / Carbamazepine intoxication in a HIV patient under artiretroviral therapy

No disponible

Estudio diagnóstico de trombofilia en pacientes jóvenes con ictus / Diagnosis of thrombophilia in young people with ictus

La mayoría de los ictus aparecen en personas de más de 50 años y asociados a factores de riesgo cardiovascular. Sin embargo, los ocurridos en pacientes jóvenes, no siempre se justifican con la arterioesclerosis, por lo que se buscan otras etiologías como las trombofilias. Los objetivos del estudio fueron 1.-Conocer la prevalencia de trombofilias y/o estados de hipercoagulabilidad en pacientes jóvenes ingresados por ictus en un hospital de tercer nivel. 2.-Conocer con qué frecuencia se realizan estudios de trombofilia en dichos pacientes. 3.-Cuáles son las características de este tipo de pacientes. Para ello se realizó un estudio descriptivo y retrospectivo, revisando las historias clínicas de todos los pacientes ingresados en el Hospital Clínico Universitario Lozano Blesa" (Zaragoza) durante el año 2004 con diagnóstico de ictus en paciente joven. Se registraron características, antecedentes de interés y estudios de trombofilia/s realizados. Se revisaron 64 pacientes, 32 de ellos fueron isquémicos. En 16 se solicitó algún tipo de estudio de trombofilia. En el estudio de trombofilia plasmática la alteración más frecuente fue el déficit de Antitrombina III, seguido de resistencia al factor V de Leiden. En el estudio de trombofilia genéticas la mutación de la Metiltetrahilrofolatorreductasa (IMTHFR), todos heterocigotos, fue el hallazgo más frecuente. Los parámetros estudiados en inmunología fueron variables e inconstantes. Conclusiones: 1.-Los estudios de trombofilias se solicitaron en menor número de lo que sería recomendable 2.-Las peticiones de estudio no son uniformes para los distintos tipos de trombofilias, siendo los estudios plasmáticos los más solicitados (AU)

Most ictus appear in people over 50 and are associated with cardiovascular risk factors. Nevertheless, those that occur in young patients are not always caused by arteriosclerosis, so other etiologies such as thrombophilias are sought. The objectives of this study were: 1.-To find out the prevalence of thrombophilias and/or states of hypercoagulation in young patients admitted for ictus in a tertiary hospital. 2.-To find out the frequency with which thrombophilia studies are carried out in such patients. 3.-To find out the characteristics of these patients. To do so, a descriptive and retrospective study was carried out, reviewing the clinical histories of all the patients admitted to the Hospital Cllnico Universitario "Lozano Blesa" (Zaragoza) during the year 2004 with diagnoses of ictus in young patients. The characteristics, interesting antecedents and thrombophilia studies carried out were recorded. 64 patients were reviewed, 32 of them showed ischemia. In 16, some type of thrombophilia study was requested. In the study of plasmatic thrombophilia, the most common alteration was antithrombin III deficiency, followed by resistance to V Leyden factor. In the study of genetic thrombophilias, the mutation of Metiltetrahifrofolato reductase (MTHFR), in all cases heterozygotic, was the most frequent finding. The parameters studied in immunology were variable. Conclusions: 1.- Thrombophilia studies are requested less frequently than would be recommendable 2.-The requests for studies are not uniform for the different types of trombofilias, plasmatic studies being the most requested (AU)

Insuficiencia cardiaca en una unidad de medicina interna en Aragón / Heart failure in an internal medicine unit in Aragón

Introducción y objetivos: La insuficiencia cardíaca (IC) es un motivo frecuente de ingreso en los Servicios de Medicina Interna. En este estudio analizamod las características epidemiológicas, métodos diagnósticos y tratamiento de los pacientes con IC ingresados en un Servicio de Medicina Interna. Métodos. Se revisaron las historias clínicas de los pacientes ingresados en una Unidad de Medicina Interna a lo largo de un año y se seleccionaron aquellos pacientes con diagnóstico de IC. Resultados. Las características epidemiológicas de este grupo fueron similares a las de otros pacientes ingresados en otros servicios de Medicina Interna de nuestro entorno, destacando la elevada edad, el predominio del sexo femenino y una importante comorbilidad asociada. Se realizó ecocardiograma en el 41,8% de los pacientes sin diagnóstico previo de IC. Aplicando técnicas de análisis multivariante no se identificaron variables que condicionarasn una menor aplicación de la ecocardiografía. La no determinación de la fracción de eyección se relacionó con una menor prescripción de inhibidores del enzima conversor de la angiotensina (IECA) (OR: 9.409, p<0,01). No se encontraron diferencias en el tratamiento con IECA y beta bloqueantes en función de la edad, sexo o etiología de la IC. La edad se asoció con una menor prescripción de tratamiento anticoagulante en pacientes con fibrilación auricular (OR 1.27; p<0,01). Los pacientes de edad elevada permanecieron menos días ingresados que aquellos más jóvenes (p<0,05). Conclusión. Se objetivo una infrautilización de la ecocardiografía así como una baja prescripción de IECA. Lo diferente de las características de estos pacientes con respecto a los que participan en los ensayos clínicos hacen que las conclusiones de estos sean difíciles de llevar a la práctica diaria

Background and objetives. Heart failure (HF) is an important cause of admission at Internat Medicine Units. In this survey we asses the epidemiological features and management of patients with heart failure in an Internal Medicine Unit. Methods. We reviewed medical records of patients admitted at Internal Medicine Unit for a year and we selected patients with diagnosis of HF. Results. Epidemiological features in this group were similar to patients admitted in others Internal Medicine Units in our country. High age, sex female predominance and Associated diseases were more noteworthy features. Echocardiogram was performed in 41.8% of patients without previous diagnosis of heart failure. Multivariate analysis did not found features that to explain a less application of echocardiography. In patients without echocardiography, angiotensin converting enzyme (ACE) inhibitors prescription was less than patients in who echocardiography was performed (OR: 9.409, p<0,01). Age, sex or etiology of HF were not associated with a significantly different prescription of ACE inhibitors and beta blockers. Age was associated with no anticoagulant prescription in patients with atrial fibrillation (OR 1.27; p<0,01). Elderly patients were discharged earlier than young patients (p<0.05). Conclusion. Under utilization of echocardiography and poor prescription of ACE inhibitors were verified. This fact result in a Epidemiological features of these patients are different than ones in patients included in clinical trials. Thus, their conclusions are difficult to apply in diary clinical practice