Mazzuoccolo L.D.,Hospital Interzonal Of Agudos Eva Peron |
Marciano S.,Servicio de Medicina Interna |
Echeverria C.M.,Hospital Interzonal Of Agudos Eva Peron
Medicina (Argentina) | Year: 2016
The ECHO® (Ex-tension for Community Healthcare Outcomes) project is a model of distance medical education. Its mission is to expand knowledge and evaluate the results of this action, both in the training of human resources in healthcare and in the accomplishment of the best medical practices in the community target. It is developed through case presentation videoconferencing, between experts in chronic and complex diseases and physicians, with the aim of reducing the healthcare asymmetries between large urban centers and peripherals areas. We have implemented this telementoring for dermatologists and residents who treat patients with psoriasis. After 10 sessions, a survey was conducted to evaluate the educational attainment of the participants. A significant improvement was found in their abilities to determine the severity of psoriasis, screening for arthritis, assessment of the patient before beginning systemic treatment and appropriate follow-up under different systemic therapies. ECHO replication model helped improve the skills of the participants in the management of this disease, and reduced professional isolation. © 2016, Instituto de Investigaciones Medicas. All rights reserved.
Quesada-Gomez J.M.,Hospital Universitario Reina Sofia |
Diaz-Curiel M.,Servicio de Medicina Interna |
Sosa-Henriquez M.,Hospital Universitario Insular |
Malouf-Sierra J.,Hospital Of La Santa Creu I Sant Pau |
And 6 more authors.
Journal of Steroid Biochemistry and Molecular Biology | Year: 2013
An observational cross-sectional study was conducted to assess calcium intake and vitamin D status by measurement of 25-hydroxyvitamin D (25(OH)D), in postmenopausal osteoporotic women (PMOW) treated and untreated for osteoporosis. To assess the influence of sunlight exposure on vitamin D status, the study group was categorized on the basis of sunlight exposure (above or below 2500 sunlight h/year). A group of 336 PMOW older than 65 years was identified (190 [56.5%] treated and 146 [43.5%] untreated for osteoporosis). The demographic and clinical data of the PMO women included history of prior fractures, pharmacological treatments and dietary calcium intake. BMD was measured by DEXA and 25(OH)D was determined by an HPLC method. Results: vitamin D serum levels were lower in the untreated group as compared with the treated group (58 ± 27 vs. 67 ± 27 nmol/l; p = 0.006). Prevalence of vitamin D deficiency (cut-off point set at <50 nmol/l) was higher in the non-treated group (43.8% vs. 29.5%; p = 0.009). Nearly all PMOW, whether treated or not for osteoporosis had a total calcium intake of less than 1200 mg. Sunlight exposure did not influence the vitamin D status. Conclusions: vitamin D deficiency and an insufficient calcium intake are highly prevalent in both treated and untreated Spanish PMOW older than 65 years. This can be related to low therapeutic adherence and/or insufficient prescription. Therefore physician's and patient's knowledge regarding the optimization of vitamin D status and calcium intake should be improved and implemented. © 2012 Elsevier Ltd. All rights reserved.
Palliative sedation in cancer patients in a hospital at home unit: A prospective analysis of 7 years of experience [La sedación paliativa en pacientes oncológicos en una unidad de hospitalización a domicilio: Un análisis prospectivo de 7 años de experiencia]
Ameneiros Lago E.,Servicio de Medicina Interna
Medicina Paliativa | Year: 2010
Bibliography shows a wide range of frequencies in the use of palliative sedation. Most of these works are retrospective studies carried out in hospitals and outside our sociocultural frame. Objetives: the aim of this article is to analyse palliative sedation, deep and continous, on cancer patients who died in a hospital at home unit, and to compare the results obtained during the unit's early years with more recent results. Methods: a prospective study was carried out between November 2000 and June 2008. These data were gathered during the initial and final stages of the research, and a comparative analysis of the results was undertaken. Results:: the studied sample was composed of 177 patients. Palliative sedation was applied to 50.8 96;96.6 % of the latter were treated with mizadolam, on a median dose of 34 mg per day. The conditions leading to sedation were: dyspnoea in 38.8 96, delirium in 35.5 96, anxiety in 24.4 %, and finally pain in 14.4 96. The average duration of sedation until death was 1.7 days. The frequency of sedation used during the first period of the study was 56.1 96, compared to 49.1 % for the second period. Conclusion: the results obtained do not significantly differ from the information present in the related literature, albeit with a high percentage of sedation. The comparative study shows a lower sedation frequency in recent years, despite the fact that differences are not statistically significant These results confirm that palliative sedation is a technique that may be performed at home, and shows that the hospital at home is a care model that warrants similar results as compared to others. Copyright © 2010 Arán Ediciones, S.L.
Parra-Ruiz J.,Hospital Universitario San Cecilio |
Duenas-Gutierrez C.,Servicio de Medicina Interna |
Tomas-Jimenez C.,Hospital Universitario San Cecilio |
Tomas-Jimenez C.,Hospital Universitario Reina Sofia |
And 3 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2012
There is a paucity of data regarding efficacy and safety of concomitant therapy of daptomycin and statins, so we reviewed patients that concomitantly received daptomycin and statins to identify any potential increase in toxicity in our cohort. This retrospective study included all patients that received >6 mg/kg/day of daptomycin along with statins and had efficacy and safety data. Patients on high dose (>6 mg/kg/day) daptomycin therapy that did not received statins served as controls. One hundred four patients were included. Median daptomycin dose was 7.8 mg/kg/day (range 6.5-10.8 mg/kg/day), for a mean duration of therapy of 17 days (range 10-51 days). Thirty-six patients received daptomycin and statins and 68 received only daptomycin. Muscular toxicity defined as CPK levels>1000 UI/L (2.5 times upper normal limit, range of determination 200-400 UI/L) was equally distributed between both groups (3/36, 8% vs 7/68, 10%; p=0.746). Despite biochemical toxicity, we did not find clinical toxicity and daptomycin treatment was completed in all cases. We did not find predictors of increased CPK during daptomycin therapy. Based on our data, concomitant administration of daptomycin and statins is safe and is not associated with an increased risk of rhabdomyolysis. © Springer-Verlag 2011.
Leuko-glycemic index in patients with ST-segment elevation myocardial infarction, a easy and useful parameter for the assessment of complications [Vencer la inercia terapéutica en el manejo del paciente dislipidémico: Un reto en la práctica clínica diaria]
Morales C.,Servicio de Medicina Interna |
Mauri M.,Hospital Of Terrassa |
Vila L.,Hospital Moises Broggi Of Sant Joan Despi
Clinica e Investigacion en Arteriosclerosis | Year: 2014
Beat therapeutic inertia in dyslipidemic patient management: a challenge in daily clinical practice.In patients with dyslipidemia, there is the need to reach the therapeutic goals in order to get the maximum benefit in the cardiovascular events risk reduction, especially myocardial infarction. Even having guidelines and some powerful hypolipidemic drugs, the goals of low-density lipoprotein-cholesterol (LDL-c) are often not reached, being of special in patients with a high cardiovascular risk. One of the causes is the therapeutic inertia. There are tools to plan the treatment and make the decisions easier. One of the challenges in everyday clinical practice is to know the needed percentage of reduction in LDL-c. Moreover: it is hard to know which one is the treatment we should use in the beginning of the treatment but also when the desired objective is not reached. This article proposes a practical method that can help solving these questions. © 2013 Sociedad Española de Arteriosclerosis.
PubMed | University of Santiago de Chile and Servicio de Medicina Interna
Type: Journal Article | Journal: Revista medica de Chile | Year: 2017
The epidemiology of critical patients in Chile could differ from that reported in international studies.To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013).A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival.We analyzed data from 1075 aged 54 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital.This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013.
Reginster J.-Y.,University of Liège |
Kaufman J.-M.,Ghent University |
Goemaere S.,Ghent University |
Devogelaer J.P.,Catholic University of Leuven |
And 7 more authors.
Osteoporosis International | Year: 2012
In an open-label extension study, BMD increased continuously with strontium ranelate over 10 years in osteoporotic women (P < 0.01). Vertebral and nonvertebral fracture incidence was lower between 5 and 10 years than in a matched placebo group over 5 years (P < 0.05). Strontium ranelate's antifracture efficacy appears to be maintained long term. Introduction: Strontium ranelate has proven efficacy against vertebral and nonvertebral fractures, including hip, over 5 years in postmenopausal osteoporosis. We explored long-term efficacy and safety of strontium ranelate over 10 years. Methods: Postmenopausal osteoporotic women participating in the double-blind, placebo-controlled phase 3 studies SOTI and TROPOS to 5 years were invited to enter a 5-year open-label extension, during which they received strontium ranelate 2 g/day (n = 237, 10-year population). Bone mineral density (BMD) and fracture incidence were recorded, and FRAX® scores were calculated. The effect of strontium ranelate on fracture incidence was evaluated by comparison with a FRAX®-matched placebo group identified in the TROPOS placebo arm. Results: The patients in the 10-year population had baseline characteristics comparable to those of the total SOTI/TROPOS population. Over 10 years, lumbar BMD increased continuously and significantly (P < 0.01 versus previous year) with 34.5 ± 20.2% relative change from baseline to 10 years. The incidence of vertebral and nonvertebral fracture with strontium ranelate in the 10-year population in years 6 to 10 was comparable to the incidence between years 0 and 5, but was significantly lower than the incidence observed in the FRAX®-matched placebo group over 5 years (P < 0.05); relative risk reductions for vertebral and nonvertebral fractures were 35% and 38%, respectively. Strontium ranelate was safe and well tolerated over 10 years. Conclusions: Long-term treatment with strontium ranelate is associated with sustained increases in BMD over 10 years, with a good safety profile. Our results also support the maintenance of antifracture efficacy over 10 years with strontium ranelate. © 2011 The Author(s).
Salinas Botran A.,Servicio de Medicina Interna |
Ramos Rincon J.M.,University Miguel Hernández |
De Gorgolas Hernandez-Mora M.,Autonomous University of Madrid
Medicina Clinica | Year: 2013
Globalization has facilitated the movement of large number of people around the world, leading modern clinicians to attend patients with rare or forgotten diseases. In the last few years many doctors are working in developing countries as volunteers or expatriates. The aim of this article is to summarize the basic epidemiological, clinical and therapeutic knowledge of the main cardiovascular diseases that a medical doctor from a developed country may attend in a tropical rural hospital, or with challenging diseases in patients coming from developing countries. © 2012 Elsevier España, S.L.
Menendez-Bueyes L.R.,University of Salamanca |
Soler Fernandez M.D.C.,Servicio de Medicina Interna
Reumatologia Clinica | Year: 2016
Paget's disease of bone is the second most common bone disease after osteoporosis. It is characterized by focal regions of highly exaggerated bone remodeling, with abnormalities in all phases of the remodeling process. This study aims to investigate the hypothesis of a possible British origin of Paget's disease of bone by studying the worldwide geographic distribution of cases identified in ancient skeletons excavated from archaeological sites. The methodology consists in reviewing cases of Paget's disease of bone described in the literature. © 2016 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología.
Lopez-Hernandez J.C.,Servicio de Medicina Interna |
Bedolla-Barajas M.,Hospital Civil Of Guadalajara Dr Juan I Menchaca
Ginecologia y Obstetricia de Mexico | Year: 2015
Spontaneous pneumomediastinum is the presence of free air contained within the mediastinum, frequently associated with subcutaneous emphysema and of atraumatic origin. Frequency during childbirth is 1 in 100,000. We report the case of a 19 year old woman without respiratory disease history, in her first pregnancy with 39.5 weeks of gestation patient had, prolonged latent phase and sudden postpartum onset of dyspnea, thoracic pain and subcutaneous emphysema. Simple X ray film and thoracic tomography revealed the presence of free air in the mediastinum. The association of pneumomediastinum during delivery is an uncommon event. © 2015, Asociacion Mexicana de Ginecologia y Obstetricia. All rights reserved.