Search

Resumen Fundamento y objetivo Los modelos predictivos de mortalidad intrahospitalaria en los servicios de Medicina Interna no han alcanzado un uso generalizado. Nuestra hipotesis es que la inclusion de pacientes de edad muy avanzada interfiere en los modelos descritos. Pacientes y metodo Se trata de un estudio de cohortes prospectivo observacional en el que se incluyeron 1.500 pacientes ingresados consecutivamente en el servicio de Medicina Interna. Se utilizo un analisis de regresion logistica basado en el modelo REMS y posteriormente se reprodujo el analisis segmentando la serie segun si la edad de los pacientes era de 85 anos o menos, o de mas de 85 anos. Resultados La mortalidad global intrahospitalaria de los pacientes incluidos en el estudio fue del 12%. A pesar de que el modelo REMS predijo una mortalidad global del 11,9%, la sensibilidad y especificidad para una prediccion individual fueron poco satisfactorias, pues el AUC (area bajo la curva) fue unicamente del 0,704. Cuando se segmento la muestra segun la edad de los pacientes, se observo que el modelo gano precision para el grupo ≤ 85 anos (AUC 0,799), mientras que la perdio para el grupo de pacientes > 85 anos (AUC 0,660). Conclusiones La edad avanzada interfiere en los modelos generales de prediccion de mortalidad intrahospitalaria. Posiblemente hay variables importantes en edades avanzadas que no se tienen en cuenta en estos modelos. Creemos que deberian disenarse modelos predictivos de mortalidad intrahospitalaria especificos para los pacientes de edad avanzada ingresados en los servicios de Medicina Interna.

Resumen Fundamento y objetivo Analizar la edad de los pacientes ingresados en los servicios de medicina interna (MI) espanoles con la hipotesis de que a lo largo de los ultimos 20 anos ha aumentado de forma significativa. Pacientes y metodo Se ha analizado, por un lado, la evolucion etaria de los pacientes del servicio de los autores. Por otro lado, datos del Conjunto Minimo Basico de Datos (CMBD) ofrecidos por el Ministerio de Sanidad. Finalmente, una serie de publicaciones de finales de los anos 80 comparandola con una serie reciente. Resultados La edad media de los pacientes ingresados en nuestro centro ha aumentado en 19,3 anos en 20 anos. Segun datos del CMBD, los pacientes ≥ 75 anos aumentaron entre el 2005 y el 2009 un 4,4%. La edad media de los pacientes ha aumentado en 8,3 anos al comparar las series historica y reciente. Conclusiones Se confirma la hipotesis de que los pacientes ingresados en MI han aumentado significativamente de edad y que este incremento es mayor que el esperado por el envejecimiento general de la poblacion.

BACKGROUND AND OBJECTIVE: Atrial fibrillation is managed in multiple settings by different specialists. We sought to analyze treatment and compliance of the prevailing guidelines of patients with atrial fibrillation attended at different levels of health care and to quantify interventions to correct treatment inadequacies. PATIENTS AND METHOD: We included all adult patients with atrial fibrillation who presented during a 14 day-period to different levels of health care of a tertiary hospital and a related primary care clinic (family physician, cardiologist, emergency department, hospitalization). In all of them, clinical and epidemiological data in relation to atrial fibrillation, and all data referring to treatment and compliance of guidelines, were recorded prospectively. RESULTS: 293 patients were included. Clinical and epidemiological data were similar in the different settings. A great diversity in atrial fibrillation treatment was observed. In 30 and 33% of the patients, antiarrhythmic and antithrombotic treatment, respectively, did not meet the recommendations of the prevailing guidelines. The adequacy was inferior in primary care. The adequacy percentages increased slightly after the medical attention (2 and 3% respectively, p non significant) with no differences in this increase between the different settings. CONCLUSIONS: There are no epidemiological differences between patients with atrial fibrillation treated at different levels of health care. An important number of patients do not follow the recommendations of the prevailing guidelines. There is a clear medical abstention in incorrectly treated cases.

Fundamento y objetivo: Diversos estudios experimentales en animales han demostrado que el monoxido de carbono (CO) tiene capacidad para unirse al complejo IV de la cadena respiratoria mitocondrial (CRM) y distorsionar el funcionalismo mitocondrial. Sin embargo, se desconoce si esta circunstancia se produce en la practica clinica diaria de los pacientes que acuden a urgencias tras haber sufrido una intoxicacion aguda por CO. El objetivo de este trabajo fue evaluar desde diferentes perspectivas si existe algun tipo de disfuncion mitocondrial en los pacientes que han sufrido una intoxicacion aguda por CO. Pacientes y metodo: Se incluyeron 10 pacientes que acudieron a urgencias tras sufrir una intoxicacion aguda por CO (carboxihemoglobina inicial, 20,4 [6]%). Siete de ellos recibieron tratamiento con oxigenoterapia hiperbarica. A todos ellos se les extrajo 20 ml de sangre durante la fase aguda de la intoxicacion, a los 3-5 dias y 10-14 dias del episodio agudo. A partir de estas muestras se aislaron linfocitos para realizar los estudios mitocondriales, que consistieron en la determinacion del contenido mitocondrial a traves de la actividad de la citrato sintasa (nmol/min/mg proteina), la actividad enzimatica (nmol/min/mg proteina) de los complejos III y IV de la CRM (ambos contienen citocromos), la actividad oxidativa (nmol oxigeno consumido/min/mg proteina) espontanea y estimulada mediante la administracion de glutamato y succinato, y la cuantificacion de la peroxidacion lipidica utilizando acido cis-parinarico. Estos parametros se cuantificaron tanto por celula (valores absolutos) como por mitocondria (valores relativos). Los resultados se compararon con los valores control historicos de nuestro laboratorio procedentes de 130 individuos. Resultados: Durante la fase aguda de la intoxicacion no se observaron cambios en el contenido mitocondrial de los pacientes con respecto al grupo control, pero si una inhibicion significativa de la actividad enzimatica de los complejos III y IV de la CRM asociada a un descenso de todas las actividades oxidativas, tanto si la estimacion se hacia por celula como si se hacia por organela (mitocondria). Aunque todas estas actividades se recuperaron a lo largo del tiempo (t1 y t2), solo en el caso del complejo IV y de la actividad oxidativa estimulada por glutamato dicha recuperacion resulto estadisticamente significativa. No obstante, ni siquiera en estos casos las actividades finales alcanzaron los valores control. Aunque se observo una tendencia al incremento de la peroxidacion lipidica, este aumento no alcanzo significacion estadistica. Conclusiones: En el presente estudio confirmamos ex vivo la existencia de una inhibicion de la actividad de la CRM en pacientes intoxicados por CO que consultan a un servicio de urgencias. Dicha disfuncion continua siendo detectable transcurridos 14 dias del episodio agudo. Esta inhibicion del funcionalismo mitocondrial podria desempenar algun papel patogenico en los sintomas y signos tardios que en ocasiones presentan estos enfermos.

To analyze the age of patients admitted to Spanish General Internal Medicine (IM) departments over the past 20 years with the hypothesis that patients' age has increased significantly.On one hand, we analyzed the age of patients admitted in the department of the authors. Secondly we analyzed data provided by the Ministry of Health. Finally we compared a number of different articles from the late eighties with a recent series.Mean age of patients in our department has increased in 19.3 years in 20 years. According to CMBD, the patients ≥ 75 years increased 4.4% from 2005 to 2009. When comparing the historical and recent series, the average age of the patients increased 8.3 years.All three sources confirm the hypothesis that patients admitted to IM are significantly older than some years ago, and that this increase in age is greater than the expected by aging of the general population.

Atrial fibrillation is managed in multiple settings by different specialists. We sought to analyze treatment and compliance of the prevailing guidelines of patients with atrial fibrillation attended at different levels of health care and to quantify interventions to correct treatment inadequacies.We included all adult patients with atrial fibrillation who presented during a 14 day-period to different levels of health care of a tertiary hospital and a related primary care clinic (family physician, cardiologist, emergency department, hospitalization). In all of them, clinical and epidemiological data in relation to atrial fibrillation, and all data referring to treatment and compliance of guidelines, were recorded prospectively.293 patients were included. Clinical and epidemiological data were similar in the different settings. A great diversity in atrial fibrillation treatment was observed. In 30 and 33% of the patients, antiarrhythmic and antithrombotic treatment, respectively, did not meet the recommendations of the prevailing guidelines. The adequacy was inferior in primary care. The adequacy percentages increased slightly after the medical attention (2 and 3% respectively, p non significant) with no differences in this increase between the different settings.There are no epidemiological differences between patients with atrial fibrillation treated at different levels of health care. An important number of patients do not follow the recommendations of the prevailing guidelines. There is a clear medical abstention in incorrectly treated cases.

Many experimental studies in animals have demonstrated that carbon monoxide (CO) has the ability to bind to complex IV of the mitochondrial respiratory chain (MRC) inhibiting its function. It is unknown, however, if this situation is also present in patients who are admitted to an emergency department because of acute CO poisoning. The objective of this study was to evaluate from different points of view whether or not mitochondrial function is abnormal in patients admitted because of an acute CO poisoning.Ten patients with an acute CO poisoning admitted in an emergency department were included in the study. Initial carboxyhemoglobin was 20.4 (6)%. Seven of these patients received hyperbaric-oxygen therapy. In all the patients, lymphocytes from 20 mL of blood were obtained at admission (t0), and at days 3-5 (t1), and 10-14 (t2). Mitochondrial content was estimated through citrate synthase activity (nmol/min/mg protein). Enzymatic activity of complexes III and IV (both containing cytochromes) as well as oxidative activities were measured. Lipid peroxidation was ascertained by means of cis-parinaric acid fluorescence. All the values were given as absolute values, and were corrected according to the mitochondrial content (relative values). The results were compared with the control values obtained from 130 historical normal individuals.During acute poisoning (t0), there were no changes in mitochondrial content. On the other hand, there was a significant inhibition of the enzymatic activity of complexes III and IV, and a decrease in all oxidative activities, considering both absolute and relative values. Although all the activities showed a trend to recuperation with time (t1 y t2), statistical significance was only observed for complex IV and for the oxydative activity stimulated with glutamate.In the present study we confirm that an inhibition of the MRC can be demonstrated ex vivo in patients attended in an emergency department due to acute CO poisoning. The inhibition is still present 14 days after the acute event. This mitochondrial dysfunction may play a pathogenic role in the persisting or delayed sings and symptoms that these patients occasionally refer.