Cuidados paliativos en pacientes trasplantados de órgano sólido / No disponible

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Hospital at home for acute respiratory patients.

BACKGROUND: The issue of "hospital at home" (HAH) for acute respiratory patients is one that is still being debated, partly because economic, cultural and health service differences between locations imply that HAH schemes need to be tailored to local situations. The aim of the present study was to analyze the feasibility and effectiveness of HAH for patients with acute respiratory disease at our institution. METHODS: Of all the patients admitted to our institution via the emergency department during a 34-day subject enrollment period, 25 with diagnoses of respiratory infection, pneumonia, pulmonary insufficiency or exacerbated chronic obstructive pulmonary disease who were living within 25 km of our center and who were willing to receive HAH care were assigned to HAH. Fifty sex-matched controls with the same diagnoses were given conventional hospital care (CHC) as inpatients. The dependent variables evaluated included time to discharge, readmissions within 3 months and deaths within 3 months. RESULTS: There were no significant differences between the HAH and CHC groups with regard to age, diagnoses, physical and analytical findings, or co-morbidity, or with regard to deaths (HAH 16%, CHC 10%) or readmissions (HAH 17%, CHC 24%). Time to final discharge was significantly shorter for HAH patients (7 days) than for CHC patients (12 days). Some 95% of the HAH patients were satisfied and would choose HAH again. CONCLUSIONS: HAH seems feasible for appropriately selected acute respiratory disease patients presenting in our emergency department. It frees hospital beds for other patients, its readmission and mortality rates are no higher than for conventional hospitalization, and, in general, it is favorably evaluated by patients.

[Clinical patterns of selective IgA deficiency: 3 case reports]. / Patrones clínicos del déficit selectivo de IgA: a propósito de tres casos.

The selective deficit of IgA is characterised by its clinical variability. This disease can be detected in non-symptomatic patients or associated to multiple diseases of different features. The allergic reactions, recurrent infections, gastrointestinal alterations, autoimmune diseases, and some neoplasias are the most frequent features of this deficit. We present 3 cases with different pathology associated to the common deficit of IgA, giving a view of the wide clinical spectrum of this process.

[Selective deficiency of IgA]. / Déficit selectivo de IgA.

The selective deficit of IgA is the most frequently acquired immunodeficiency. It is important because of this and the variability of the clinical presentation, which might be non-symptomatic or simply show several clinical features. The prognosis depends on the associated clinical affliction. There is no substitute treatment for this immunodeficiency, in which the immunoglobulins administration produces a paradoxical antibody formation against this, and adverse immunological reactions. We reviewed the immunodeficiency in this paper, highlighting the frequency, pathogenia, clinical diversity and therapy.

[A diffuse nonsecreting osteosclerotic myeloma with polyneuropathy, organomegalies, endocrinopathies and skin changes]. / Mieloma osteosclerótico difuso no secretante con polineuropatía, organomegalias, endocrinopatía y alteraciones cutáneas.

A patient admitted into hospital suffering from quadriparesis, secondary to distal symmetric sensitive and motor polyneuropathy, is presented. Diffuse osteosclerotic bone changes associated to neurological symptoms were detected and histologically confirmed as non-secreting plasmacytoma, on noting the non-production of paraprotein. Also, there were endocrine, skin and systemic alterations. We comment on the association of these changes as POEMS syndrome, discussing the pathogenesis and giving details of the treatment, emphasizing the excellent response.