Estudio del consumo de fármacos inadecuados o no indicados en el anciano que ingresa en un Servicio de Medicina Interna / Study of the consumption of innapropiate medicaments in elder hospitalized in the internal medicine service

Introducción: Los pacientes ancianos se caracterizan por el alto grado de polimedicación. Este factor se ha mostrado el más importante en la aparición de efectos adversos (EAF). El estudio de los fármacos ayuda a establecer cuales son inapropiados y por lo tanto se deben retirar, disminuyendo de esta forma la posibilidad de EAF. Material y Métodos: Estudio prospectivo y observacional. Criterio de inclusión: pacientes de > 64 años que ingresan en Medicina Interna. Se definió como fármaco inapropiado los medicamentos de baja utilidad terapéutica (UTB), los no indicados, y los inadecuados para el anciano. Mediante el programa informático SPSS 11.5 se analizaron las posibles variables relacionadas con el consumo. Resultados: Se incluyeron en el estudio 172 ancianos. La media de medicamentos por persona y día fue de 5,34 (0-15). El 52,5% consumían un fármaco inapropiado (36,6% inadecuado para el anciano, 15% noindicado y 12% UTBs). El análisis multivariante asocia el consumo de estos fármacos a un mayor número de patologías (p < 0,012), a un mayor consumo de medicamentos (p < 0,001) y a la procedencia de residencias de ancianos (p < 0,001). Sólo el consumo de fármacos no adecuados para el anciano se asocia a aumento de EAF. Conclusión: La mitad de los ancianos toma al menos un fármaco deforma innecesaria, y la mayoría de estos fármacos favorece la aparición de EAF

Background: The elderly patients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD’s possibility. Patients and Method: Prospective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed. Results: 172 elders were included in the study. The average of medicines for person and day belonged to 5.34 (0-15). 52.5% was consuming an inappropriate medicament (36.6% inadequate for the elder, 15% not indicated, and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p <0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.001). Only the consumption of medicaments not adapted for the elder is associated with increase of EAD. Conclusion: The half of the elders takes at least a medicament of unnecessary form, and the majority of these medicaments favors appearance of EAD

[Study of the conpsumption of innapropiate medicaments in elder hospitalized in the Internal Medicine Service]. / Estudio del consumo de fármacos inadecuados o no indicados en el anciano que ingresa en un Servicio de Medicina Interna.

BACKGROUND: The elderly patients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD's possibility. PATIENTS AND METHOD: Prospective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed. RESULTS: 172 elders were included in the study. The average of medicines for person and day belonged to 5.34 (0-15). 52.5% was consuming an inappropriate medicament (36.6% inadequate for the elder, 15% not indicated, and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p < 0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.001). Only the consumption of medicaments not adapted for the elder is associated with increase of EAD. CONCLUSION: The half of the elders takes at least a medicament of unnecessary form, and the majority of these medicaments favors appearance of EAD.

[Preliminary study of the drug consumption in hospitalized elders]. / Estudio piloto sobre el consumo de fármacos en ancianos que ingresan en un hospital.

BACKGROUND: The absence of studies that evaluate the effect of the medical acts is an example of "mala praxis". The irrational use of medications is one of these cases. This study shows the characteristics of the drugs consumption in elders. MATERIAL AND METHODS: We include 53 elders hospitalized between 1/02/02 and the 31/05/02. RESULTS: The elders received an average of 6.45 medicaments/day. The factors of more consumption are the origin from nursing home residents and the number of previous surgeries. The adverse effects were related in 25% of the hospitalizations. CONCLUSIONS: The basis of this situation is in the loss of the global perspective of the patients and in the abuse of the sanitary resources. Each drug is the result of an isolated medical act, determining the appearance of iatrogenic disease.

Estudio piloto sobre el consumo de fármacos en ancianos que ingresan en un hospital / Preliminary study of the drug consumption in hospitalized elders

Fundamento: La ausencia de estudios sobre el resultado de actos médicos conlleva mala praxis. El uso irracional de fármacos es uno de estos casos. Este estudio muestra las características del consumo de medicamentos en mayores de 65 años. Material y métodos: Se incluyeron 53 pacientes mayores de 65 años ingresados desde el 1/02/02 al 31/05/02. Resultados: La media de fármacos es 6,45/día. Los factores de mayor consumo son la procedencia de residencia y la existencia previa de un mayor numero de cirugías. El 25 por ciento de ingresos está relacionado con efectos secundarios. Conclusiones: La perdida del enfoque global del enfermo y el abuso de los recursos sanitarios son la base de esta situación. Cada fármaco es el resultado de actos médicos aislados, condicionando el desarrollo de iatrogenia (AU)

Afectación neurológica en la esclerosis sistémica progresiva. Un problema no resuelto / Neurologícal involvement in progressive systemic sclerosis. A cleared up problem

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Fallo renal agudo por embolia en arteria renal / Acute renal failure by renal artery embolism

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Natural killer cell proliferation and renal disease: a functional and phenotypic study.

We describe a 57-year-old woman who presented with a constitutional syndrome, glomerulonephritis, and lymphocytosis. The phenotypic study, using flow cytometry, showed an expansion of natural killer (NK) cells (CD2+, CD3-, CD16+, CD56+, and CD7+). We performed a functional study of peripheral blood mononuclear cells (PBMCs) and of purified CD16+ cells (NK cells) and CD3+ cells (normal T cells). The expanded NK cell population, CD16+, did not proliferate with phytohemagglutinin (PHA) or anti-CD3 but showed a dose-dependent proliferation with recombinant interleukin-2 (rIL-2) and also proliferated with phorbol dibutyrate. This population showed very strong NK and lymphokine-activated killer cell (LAK) activities. The patient's symptoms resolved spontaneously without treatment. Three years later, however, there is still abnormal renal function, and the expansion of NK cells persists, although with no indication of malignancy. We review the features of the different large granular lymphocyte proliferations and their seldom described relationship with renal disease.

[Cerebral abscess. Clinical review of 26 cases]. / Abscesos cerebrales. Revisión clínica de 26 casos.

BACKGROUND: The introduction of new diagnostic and therapeutic techniques has changed the clinical attitude and consequences of brain abscesses (BA). OBJECTIVE: To analyse clinical-radiological features, therapy, prognostic factors and evolution of BA in our institution. MATERIALS AND METHODS: Retrospective study of all clinical records of patients diagnosed with BA from 1982 to 1992. RESULTS: Twenty-six patients with a mean age of 46.2 years were selected. The incidence was 2.6 patients/10,000 admission/year. Among 17 patients (65%) some extraprenchymatous infectious focus was found, which was located at the otorhynolaryngeal area in twelve patients. Mean duration of symptoms was 12.9 days, headache being the most common of them (69%). With CT 18 patients had a single mass, eight patients multiple masses, and 21 patients a ring enhancement when the contrast material was introduced. The causative organism was recovered from 15 patients. The organism recovered more frequently were Streptococcus spp, Enterobacteriaceae and Staphylococcus aureus. Twenty patients (77%) underwent surgical therapy, which consisted in ablation (12) or drainage (8). All patients received antibiotics for a mean of 37 days: the most frequent antibiotic combination used was penicillin+chloramphenicol. Six patients died (23%) and 7 remained with sequelae. Although statistically non-significant, the acute presentation was associated with a higher mortality rate, and the use of dexamethasone was associated with a lower mortality rate (p = 0.053 and 0.062, respectively). CONCLUSIONS: BA is associated with a high mortality rate and a high sequelae rate despite appropriate diagnostic and therapeutic measures. ORL infection is the most frequent predisposing factor. The use of dexamethasone is not associated with a higher mortality rate.

[Glycogenosis type III and Crohn disease with associated ankylopoietic spondylitis and secondary amyloidosis. An unusual coincidence]. / Glucogenosis tipo III-A y enfermedad de Crohn con espondilitis anquilopoyética asociada y amiloidosis secundaria. Una singular coincidencia.

We present a member of a family with glycogen deposit disease (GDD) type III (Forbes-Cori's disease) confirmed postmortem through enzymatic analysis of the hepatic and muscular tissues, coinciding with a Crohn's disease associated to ankylopoietic spondylitis, with final development of an extended secondary amiloidosis, all of these diagnosis established in life of the patient and verified in necropsy. We comment this rare finding, the absence of similar cases in the bibliography and the fortuitous nature of this association given the impossibility to suggest another relationship.

[Spinal epidural abscess. 8 years' experience]. / Absceso epidural espinal. Experiencia de ocho años.

We present four cases of spinal epidural abscess diagnosed in Clinica Puerta de Hierro between 1982 and 1990. In three cases the localization was thoracic and in one it was lumbar. Fever and vertebral pain were the more constant clinical symptoms. Lumbar punction showed findings in Cerebro-Spinal Fluid compatible with a parameningeal inflammation focus in the three cases it was performed. Diagnosis was established with myelography or Computerized Axial Tomography. Treatment in two cases was laminectomy and systemic antibiotics: and only antibiotics in the other two cases. Evolution was favorable in the patients who underwent surgery, but the patients treated conservatively had a fatal outcome.