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Abstract Objectives The aim of this study is to analyze the association between the degree of frailty and inappropriate prescribing patterns at admission to an Acute Care of the Elderly Unit (ACE Unit). Methods Prospective observational study conducted in the ACE Unit of an acute hospital in Barcelona city between June and August 2021. Epidemiological and demographic data were collected during hospitalization. Comprehensive geriatric assessment was performed on admitted patients. We recorded frailty (FRAIL scale), extreme polypharmacy (10 or more drugs), central nervous system potentially inappropriate medications‐PIMs (STOPP‐CNS or group D), cardiovascular potential prescribing omissions‐PPOs (START‐CV or group A), and anticholinergic burden using the drug burden index (DBI). Results Ninety‐three patients were included, of whom 48 (51.6%) were male, with a mean age of 82.83 (SD 7.53) years. The main diagnosis upon admission was heart failure in 34 patients (36.6%). Frail patients were older, with more dependence of activities of daily living and more comorbidity than non‐frail patients. Additionally, frail patients demonstrated more omissions according to the START‐A criteria. No statistically significant differences were observed in term of extreme polypharmacy, PIMs, or anticholinergic burden. Conclusions In the current study we found an association between frailty and inappropriate prescribing, specifically with regard to omissions using the START criteria for the cardiovascular system (group A). Notably, frail patients exhibited more omissions compared to their non‐frail counterparts, and this difference was statistically significant.

Background: Anterior cruciate ligament (ACL) tears are common, especially in athletes, and are often treated with hamstring tendon autografts using a single-bundle technique. Graft diameter is crucial, with evidence showing that larger grafts reduce failure risk. Asian populations typically have smaller graft diameters. This study compares the clinical outcomes of the five-strand versus the quadrupled technique in a Filipino Asian population to assess potential benefits in graft thickness and knee stability. Objective: To compare the functional outcomes, graft sizes, failure rates, and time to return to sports between five-strand and quadrupled hamstring tendon autografts in ACL reconstruction. Methodology: This ambi-directional cohort study involved Asian Filipino patients aged 18–50 with unilateral ACL tears who underwent single-bundle ACL reconstruction with either quadrupled or five-strand hamstring autografts between January 2022 and August 2023. Data on graft dimensions, IKDC scores, and time to return to sports were collected pre- and postoperatively. The analysis included descriptive statistics, Fisher’s exact test, t-tests, and ANOVA, with significance at p < 0.05. Result: The study included 18 patients, showing no significant differences in demographic characteristics such as age (24.78 vs. 27.67 years, p = 0.202), height (1.71 vs. 1.64 meters, p = 0.146), weight (84.43 vs. 74.98 kg, p = 0.252) or body mass index (28.95 vs. 27.98 kg/m², p = 0.714); average return to sports (10.63 vs. 11.83 months, p = 0.642). There was no significant difference in thicknesses (p = 0.089) and lengths (p = 0.885) of the graft. IKDC scores showed no significant differences between the two groups in pre- or postoperative outcomes at six months and one year. Complications were minimal, with no significant difference found. Conclusion: Both the five-strand and quadrupled techniques demonstrated similar demographics, graft dimensions, and clinical outcomes, indicating comparable functional results and safety profiles.

Purpose: The aim of this study is to analyse adverse health outcomes at hospital discharge adjusted to frailty degree measured by three instruments in patients admitted for medical diseases in an Acute Care for Elders (ACE). Methods: This is a prospective observational study, including 194 frail patients aged 75 years or older. Patients were admitted to a tertiary hospital ACE for an acute medical illness or exacerbated chronic diseases from June 2022 to May 2023. Frailty was assessed by the FRAIL scale, the Clinical Frailty Scale (CFS) and the frail-VIG Index (IF-VIG). Health outcomes analysed were length of hospital stay, home destination at hospital discharge, development of delirium and functional decline. Results: Patients were on average 85,14 years old, with 56 % women. Mean frailty punctuations were 2,83 for FRAIL scale; 4,1 for CFS and 0,3 for IF-VIG. Patients who did not return home were more fragile: FRAIL 3,1 vs 2,6; CFS 4,5 vs 4,0; IF-VIG 0,3 vs 0,2. Patients with a hospitalization longer than 10 days were more fragile: FRAIL 3,9 vs 2,6; CFS 4,5 vs 3,8; IF-VIG 0,3 vs 0,2. More frail patients had greater delirium incidence and prevalence: CFS 4,7 vs 4,1; IF-VIG 0,3 vs 0,2. These results are statistically significant. Conclusions: A greater degree of basal frailty during a hospitalisation in an ACE is strongly related with smaller return home rates at hospital discharge, as well as with longer mean stay-length and larger amounts of delirium.

Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs.Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug–drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs.Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%.Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.

Resumen: Las visitas de pacientes con multimorbilidad, cronicidad compleja y fragilidad a los servicios de urgencias hospitalarios son un desafío creciente. Se presenta una estrategia local, basada en listados de preselección automatizada, una enfermera gestora de casos con experiencia específica y un consenso de derivación multinivel. Se muestra la factibilidad con 368 alertas identificadas, el 85% (n = 315) bien seleccionadas. La edad, la fragilidad, el porcentaje de atención domiciliaria, el índice de Barthel y la cognición fueron consistentes con los niveles de atención/derivación (primaria, intermedia y especializada) según criterios previamente consensuados. Con la generalización actual de los sistemas de información y análisis de datos, el rol creciente de enfermería avanzada y unos recursos sanitarios bien estructurados entre niveles, una selección automatizada, junto al consenso en circuitos y perfiles clínicos y la valoración autónoma de enfermería gestionando casos multifrecuentadores, podría mejorar, de forma proactiva y sencilla, una distribución entre niveles de las alertas más coherente con las necesidades sociosanitarias. Abstract: Visits to hospital emergency departments by patients with multimorbidity, complex chronic conditions, and frailty are becoming an increasing challenge. A territorial strategy has been developed, based on automated preselection lists, a nurse case manager with specialized experience, and a multi-level territorial referral consensus. The feasibility of this approach has been demonstrated, with 368 alerts detected, 85% of which were well-selected. Age, frailty, home care percentage, Barthel index, and cognition were progressively aligned with levels of care/referral (primary, intermediate, and specialized) according to previously agreed criteria. In 2024, there is extensive structured technical information, an expanding role for advanced nursing, and well-established inter-level service resources. Therefore, through automated selection, a consensual territorial protocol of pathways and clinical profiles, and autonomous nursing assessments managing multi-frequent cases, it would be possible to achieve, in a proactive, simple, and scalable manner, an appropriate distribution of alerts across levels, consistent with the social and healthcare needs of the patients.

The purpose of a terminological definition is to represent in natural language the most relevant knowledge associated with a term. However, the knowledge activated by a term (i.e., its meaning) varies according to the usage context. Since context is indispensable in meaning construction, it should guide terminological definition writing. Nonetheless, the recommendation is still that a terminological definition should represent a concept's necessary and sufficient characteristics, which are regarded as context-independent. This paper proposes a parametrization of the contextual constraints applicable to terminological definitions so that context can be accounted for in them. To this end, the notions of premeaning and precontext are introduced, and different types of contextual constraints (linguistic, thematic, cultural, etc.) are discussed. We argue that the conscious application of contextual constraints by the terminologist helps to produce more useful definitions and to avoid inconsistencies and biases.

Abstract Background The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). Methods Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3 −, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. Results We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002–0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01–1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43–3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02–0.18], p

Introducción: Un mortinato, es un evento del embarazo que supone un resultado negativo para padres, familias y personal de salud involucrado. La falta de recursos podría ser el principal obstáculo al acceso de atención prenatal, síntoma de inequidades en salud. El débil conocimiento de causas de mortinatalidad se asocia a la creencia de que son inevitables; sin embargo, muchos factores vinculantes son potencialmente modificables.Objetivo: Describir las causas de mortinatalidad en Chile.Material y métodos: Estudio transversal y analítico. El análisis se precisó desde las 22 semanas gestacionales, según criterio estándar de la Organización Mundial de la Salud. Las causas de mayor frecuencia se utilizaron para determinar asociación mediante test con nivel de significación estadística pResultados: El mayor porcentaje de muertes fetales se registró a las 35 o más semanas (35,63%). Principales macro-causas de mortinatalidad fueron tipo: fetal (47,0%), placentaria (31,4%) y desconocida (10,89%). Principales causas específicas fueron: hipoxia intrauterina (24,4%), causa no especificada (10,87%), y anomalías morfológicas-funcionales placentarias (10,83%). Causa específica hipoxia intrauterina se asocia a edad gestacional, edad materna y nivel educacional materno (pConclusiones: La salud prenatal es reflejo de atención obstétrica, calidad y progreso en atención sanitaria. Existen brechas en detección de causas y calidad de los registros, por lo que las causas desconocidas tiendan al alza en el tiempo. Es recomendable adicionar al registro de muertes fetales componentes temporal, biológico y social maternos.Palabras claves: Mortinatalidad, muerte fetal, inequidades en salud, resultado del embarazo, causas de muerte, factores de riesgo.

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p

BackgroundNumerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL.MethodsA single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months.ResultsSeven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1-21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2-68.2).ConclusionsAlmost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.

Cytomegalovirus (CMV) is a double-stranded DNA virus. It is an opportunistic infection that usually affects individuals with AIDS or with profound immunosuppression. CMV retinitis is the most frequent ocular manifestation. Infrequently, this pathology has been observed in patients undergoing immunosuppressive treatment due to autoimmune diseases. This article presents a case of Crohn's disease with systemic and ocular involvement by CMV after starting treatment with infliximab (anti-tumor necrosis factor-alpha antibody).

Objetivo: Analizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Método: Estudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos. Resultados: De 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p

We report, to our knowledge, the first successful treatment of novel Influenza A (H1N1)/2009 chronic pericardial effusion in an adult. This patient presented on admission respiratory failure and cardiac tamponade which required non invasive ventilation and drainage. Pericardial fluid polymerase chain reaction sequences were positive for Influenza A (H1N1)/2009 virus. Any other etiologies were discarded. Recidivating pericardial effusion after medical treatment, firstly with Oseltamivir, and afterwards, with colchicine and corticosteroids during six months, was solved with pericardiectomy.

Resumen: La coartación de la aorta abdominal es una afección vascular no hereditaria poco frecuente, que afecta a hombres y mujeres por igual. Recientemente ha sido nombrada como “Síndrome aórtico medio”, y los hallazgos clínicos son similares a los de la CoAo típica. Para el diagnóstico, se debe recurrir a la resonancia magnética o a la arteriografía, y las opciones terapéuticas incluyen la dilatación percutánea con catéter-globo, el tratamiento quirúrgico y, por último, como opción más novedosa, la implantación de prótesis endovasculares. En este artículo presentamos el caso de una mujer de 45 años de edad, exfumadora, con antecedentes de artritis reumatoidea e hipertensión arterial que presentaba claudicación de miembros inferiores durante la marcha. Existía una disminución bilateral marcada de los pulsos femorales y el Doppler, y mostró un componente amortiguado en ambas arterias femorales y poplíteas. La AngioTAC encontró una estenosis significativa del tercio distal de la aorta abdominal infrarrenal, con hipoplasia marcada de la ilíaca derecha. La aortografía corroboró el diagnóstico (gradiente de 80 mmHg). A través de dos introductores arteriales por las arterias femorales se avanzaron dos catéteres-globo MATCH-35 de 5.0x80 mm que se inflaron simultáneamente y posteriormente, se implantó un stent MEDTRONIC “Bridge Assurant” de 10 x 30 mm en el segmento estenótico, sin complicaciones. El gradiente residual fue de 10 mmHg. La paciente evolucionó favorablemente y fue egresada a las 24 horas del procedimiento. / Abstract: Coarctation of the abdominal aorta is an uncommon, non-inherited vascular condition that affects men and women alike. It has been recently named as "middle aortic syndrome", and the clinical findings are similar to those of typical aortic coarctation. For diagnosis, one must make use of magnetic resonance imaging or arteriography, and therapeutic options include percutaneous balloon catheter dilatation, surgical treatment and, finally, as a more novel option, the implantation of stents. In this paper we present the case of a 45-year-old female, ex-smoker with a history of rheumatoid arthritis and hypertension who presented claudication of lower limbs during gait. There was a marked bilateral decrease of the femoral and Doppler pulses, and showed a damping factor in both femoral and popliteal arteries. The CT angiography found a significant stenosis of the distal third of the infrarenal abdominal aorta with marked hypoplasia of the right iliac. Aortography confirmed the diagnosis (gradient of 80 mmHg). Using two arterial sheaths, two-balloon catheters MATCH-35, 5.0x80 mm were introduced through femoral arteries, simultaneously inflated and subsequently a MEDTRONIC "Bridge Assurant" stent of 10x30 mm was implanted in the stenotic segment; with no complications. The residual gradient was 10 mmHg. The patient improved and was discharged form the hospital 24 hours after the procedure.