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Objective: To determine whether an educational intervention strategy would improve the frequency of medical prescriptions for adequate thromboprophylaxis in a medicine service. Methods: Quasi-experimental study, in which in the pre-intervention phase the frequencies of indication of appropriate thromboprophylaxis by physicians from the medicine service were obtained. An 8-week educational intervention was carried out with this same group of doctors. In the post-intervention phase, the frequency of adequate thromboprophylaxis was measured at 2 and 4 months after the intervention. Results: The educational intervention was implemented in 112 resident physicians in medicine specialties. All prescriptions were made by the first-year resident physicians and endorsed by their supervising physician. Prior to the intervention, 47 (44.35%) adequate prescriptions were obtained, 13 (12.26%) suboptimal, 4 (3.77%) inadequate, and 42 (39, 62%) no prescription. After the intervention, the following 2 months were obtained: 78 (75.72%) adequate prescriptions, 7 (6.79%) suboptimal, 4 (2.91%) inadequate and 15 (14.58%) no prescriptions, there being a significant difference with the baseline level. At the subsequent 4 months post-intervention, the following were obtained: 86 (83.49%) adequate, 5 (4.85%) suboptimal, 2 (1.94%) inadequate and 10 (9.72%) no prescription, with a difference significant with the baseline level. There was no increase in the frequency of overuse. Conclusions: The application of an educational strategy to medical personnel was effective in increasing correctly indicated thromboprophylaxis prescriptions in a medical service. No overuse of thromboprophylaxis was found after the intervention. [ABSTRACT FROM AUTHOR]

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Updates to the Guidelines for the Management of High Blood Pressure and the Guidelines for the Management of Dyslipidemia have been recently published in the eighth report of the Joint National Committee. Both are evidencebased and rely on clinical trial results, leaving aside, when possible, recommendations made by experts. Both have introduced important methodological changes in the form of cataloging and summarizing the evidence used. The High Blood Pressure Guideline is considered to be a reliable guide; it has simplified recommendations and is easy to implement. A potentially interesting change in the Dyslipidemia Guideline is the abandonment of the numerical therapeutic target in order to use the modification of the level of risk, which could promote a discussion about the intensity of treatment, and initiate shared decision-making. [ABSTRACT FROM AUTHOR]

A 55-year-old man with a two weeks history of lethargy, weakness, hyporexia and headache. Laboratory tests showed anemia, severe hyponatremia, elevated creatine kinase and transaminasas levels, elevated TSH and very low levels ofT4 and T3. Diagnosis of myxedema coma was established and treatment was begun with oral levothyroxine, IV corticosteroids and hypertonic saline. Because of worsening clinical status a centrat venous catheter was placed without complications with IV midazolam as sedative. Patient developed respiratory insufficiency, decreased mental status and died. Metabolism of midazolam is impaired, and its use can cause respiratory insufficiency in the setting of hypoventilation associated with hypothyroidism. [ABSTRACT FROM AUTHOR]

A 22 year old male patient was admitted to the emergency room at the Hospital Nacional Cayetano Heredia with a history often days of fever, malaise and night sweats, accompanied by asthenia, mild dyspnea, and cough. His past medical history is unremarkable. Once admitted he developed acute heart failure and poricardial effusion, the analyses of the pericardial fluid and biopsy only showed no specific inflammatory changes. Antibiotic therapy was initiated by the patient progressively worsened. During the hospitalization he presented an evanescent rash and oligoarticular arthritis with culture negative and non inflammatory effusion. Because of the exclusion of infections and neoplastic disease and the clinical picture of prolonged fever with rash and oligoarticular arthritis we were concerned about the possibility of Still's disease. We asked for serum ferritin levels which showed and extreme elevation (95 873 ng/mL). Prednisone therapy with 60mg/d was iniciated, and the fever decreased and the patient felt better. We excluded others diseases and suggested the diagnosis of Adult onset Still's disease with myopericarditis as initial manifestation. [ABSTRACT FROM AUTHOR]

Objectives: To describe the clinical findings and prognostic factors of SLE in the medical ICU in Hospital Nacional Cayetano Heredia. Materials and methods: Retrospective data gathering of clinical and laboratory findings of patients with SLE in our medical ICU during 1999-2004. Statistic descriptive analysis and univariate analysis for discrete and continuous variables were performed. APACHE II score was calculated and its prognostic value was evaluated. Results: There were 26 patients with SLE, recovering 21 complete records of them. SLE prevalence in our hospital ICU was 1.49% and was the most frequent rheumatic disease in this setting. Mortality was 57.69%. The most frequent cause of ICU admission was respiratory failure, mostly due to infectious etiologies. Data significantly associated to mortality were high ESR, severe anemia, severe hypoalbuminemia, PaFi02 less than 200 on admission. APACHE II score was significantly higher in the deceased group. Acute renal failure required dialysis and mechanical ventilation were significantly associated with mortality. Conclusions: SLE patients in Hospital Nacional Cayetano Heredia medical ICU have a high mortality, even higher than previous studies. Poor prognostic factors were: high ESR, severe anemia, severe hypoalbuminemia, PaFi02 less than 200, high APACHE II score, necesity of hemodialysis and mechanical ventilation. [ABSTRACT FROM AUTHOR]

El artículo trata el efecto del ligando del receptor activador del factor nuclear κB (RANKL) y de la osteoprotegerina en el periodonto. Explica que los dientes cuentan con un sistema inmunitario especial en el área donde se unen la raíz y la encía. Nota que, con la interrupción de la integridad epitelial, incrementan los linfocitos B y T y los macrófagos. Menciona que el RANKL aparece en los osteoblastos y en los linfocitos T activados.