[Severe and reversible optic neuropathy by ethambutol and isoniazid]. / Neuropatía óptica severa y reversible por etambutol e isoniazida.

Ethambutol and isoniazid are antimicrobial agents used to treat multi-drug-resistant tuberculosis. The most commonly recognized toxic effect of these drugs is optic neuropathy, usually manifesting as a decrease in visual acuity, deficits in colour vision and cecocentral scotomas. This study presents the case of a 59-year-old Nigerian woman diagnosed of multi-drug-resistant tuberculosis who developed a severe bilateral optic neuropathy induced by ethambutol and isoniazid. Ophthalmologic examination revealed normal intraocular pressure, normal funduscopic examination and normal biomicroscopy. Automated visual field revealed 360º peripheral constriction and central scotoma. Magnetic resonance images of the brain and orbits were normal. Ten months after suspending treatment, the patient recovered complete visual function. Visual loss is a rare complication that can be related to ethambutol and isoniazid toxicity. Both eyes are usually symmetrically affected with deficits in colour vision and cecocentral scotoma. For successful treatment of visual loss, it is important to make a differential diagnosis between infection and adverse effects of anti-TB drugs. Ophthalmological examination is thus important before and after treatment.

[A iatrogenic pathology study in an internal medicine service]. / Estudio de la patología iatrógena en un servicio de Medicina Interna.

BASIS: It's obvious that the current medicine practice generates iatrogenesis . However, we are unaware about its magnitude and severity, specially in Spain, where this item has been scarcely studied. METHODS: All the patients admitted to the Department of Internal Medicine were prospectively studied during a 13 months period, selecting among the patients those fulfilling criteria for an iatrogenic problem both of pharmacological origin and not pharmacological. The kind of iatrogenesis, its severity, related mortality, gravity of the basic illness, affected organ and avoidability of the iatrogenesis were evaluated. Infusion phlebitis were recorded only during 6 months. RESULTS: Iatrogenic pathology was found in 228 cases over 1.549 patients admissions, accounting for 14.7% of incidence. Iatrogenic pathology was the reason for admission in 65 cases. The average stay was significantly increased in patients with iatrogenic pathology (p < 0.01). Adverse reactions to drugs accounted for 62% of the total account with 141 cases. The non-steroids antiinflammatory (NSA) drugs were the most frequently troublesome pharmacological agents. The GI tract was the more affected system (84 cases). Infusion phlebitis are not included in the total account of cases. CONCLUSIONS: a) iatrogenic pathology is an illness of very high incidence in our surroundings; b) NSA is a group of drugs generating frequently adverse reactions in off-hospital environment; c) GI hemorrhage is an iatrogenic illness accounting for high percentage of cases; d) many of the iatrogenic events can be catalogued as avoidable and with more accurate attention to some factors the more of them could be prevented.

[Antibiotic treatment for acute episodes of chronic obstructive pulmonary disease]. / Tratamiento con antibióticos de las agudizaciones de la enfermedad pulmonar obstructiva crónica.

Antibiotic therapy for acute episodes of chronic obstructive pulmonary disease (COPD) is a controversial issue still not clarified. In order to evaluate the effectivity of the antibiotic therapy, we designed a double-blind controlled and randomized clinical trial, in which 90 patients hospitalized due to an acute episode of COPD were divided into three groups: group I, cotrimoxazole (29 patients); group II, amoxicillin-clavulanic acid (32 patients) and group III, placebo (29 patients). Gasometric and spirometric measures were taken in addition to clinical evaluation at hospital admission and discharge using a numerical valoration system. All patients were treated with common bronchodilators. The three groups were homogeneous at their admission and there were no statistical differences at their discharge. We conclude that antibiotics do not play a relevant role in the improvement of acute episodes of COPD.

[The computerization of the clinical history in an internal medicine service]. / Informatización de la historia clínica en un servicio de medicina interna.

BACKGROUND: The following objectives were studied in the implementation of computerization in the registration of clinical histories: gather all the information obtainable from the patient, be able to up-date the information once introduced, use of the information by health care personnel, automatic carrying out of all routine reports, elaboration of hospital indexes, follow the conventional model of clinical history as much as possible and reasonable price. METHODS: The study was carried out in a 40-bed department of internal medicine in a county hospital. A mixed system of partial coding was used combined with free texts, the latter being with no limit of space. The clinical histories were structured in 9 groups which covered from personal data to complementary explorations. A personal computer compatible "AT" was employed. The program was designed and analyzed by internal medicine doctors using CLIPPER and language "C". RESULTS: The thousand one hundred histories were opened with the space occupied in the disc being of 7 Megabytes. Following the premise of: "write all data only once", the obtaining of all type of documents, indexes and listed was automatized facilitating the knowledge of the working of the department directly. Adaptation by medical personnel was good. CONCLUSIONS: The model presented achieved the previously mentioned aims of information gathering and up-dating, use of the information by hospital personnel, automatization of routine reports and indexes, the following of conventional models and economic feasibility. Computerization should not be imposed, must not represent more work and advantages should be obtained by its use.