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Objectives: To describe the care provided at the end of life for patients who die in internal medicine departments., Methods: An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death., Results: The study included 1,447 patients with a median age of 84 years. Of these, 1,065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; P<.001), knew their prognosis (42.6% vs. 8.6%; P<.001), received psychological care (24.9% vs. 8.6%; P<.001), died in an individual room (64.6% vs. 44.4%; P<.001) and were accompanied (81.9% vs. 71.9%; P=.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; P=.002)., Conclusions: There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer., (Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations., (Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Introduction: Neurocysticercosis (NC) is the most prevalent parasitic infection in the CNS. Its frequency in our environment has increased with migratory movements. The clinical and demographic characteristics of patients with NC attended in a third level hospital in an area with a high prevalence of immigrant have been analyzed., Patients and Methods: A retrospective study was done of the patients registered by the Coding Service of Virgen de la Arrixaca Hospital (January 2996 to December 2009), analyzing all the clinical histories of patients discharged with the primary or secondary diagnosis of neurocysticercosis. The most relevant epidemiological, diagnostic and therapeutic data were analyzed., Results: 35 patients were included in the study. Of these, 24 were men, all coming from Latin America. The most prevalent onset was seizure episode (27 patients). The number of cases per year began to increase after 2002. Although only 21 of the cases had criteria to begin medical treatment with albendazole, it had been prescribed to 29 patients., Conclusion: In Murcia, NC is mainly an imported disease. An increase in the annual incidence has been observed since 2002, parallel to the rise in the number of immigrants. Approximately 25% of the patients received treatment in spite of not having antiparasitic treatment indication., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Background: Staphylococcus aureus bacteremia continues to be a major problem in hospitals due to its high prevalence, severity and treatment difficulties. This study aimed to evaluate epidemiological and clinical features, risk factors and influence of antibiotic choice in outcome and mortality in patients with methicillin susceptible S. aureus bacteremia (SAMSB)., Patients and Methods: A prospective, observational study of inpatients with SAMSB (2000-3)., Results: A total of 131 with SAMSB were included (mean age 56 years; 58% > or = 60 year-old); 56.5% were due to nosocomial bacteremia; 46% of all patients had an underlying condition (diabetes mellitus being the most frequent [28%]); a risk factor for bacteraemia was identified in 98% (intravenous catheter: 72%). Mortality rate was 16% (21/131). Comparative analysis according to nosocomial or community acquisition showed that the former was more frequent in Surgical Wards, patients with intravenous or urinary catheters, traumatic patients, dialysis and ICU patients. Initial severity and mortality were highest in community-acquired SAMSB. In multivariate analysis, risk factors associated with higher mortality were: presence of an ultimately or rapidly fatal underlying disease, acute severity of illness at onset and inadequate empirical treatment., Conclusions: SAMSB is a clinically severe infection that occurs in patients with baseline disease, especially diabetics, that is almost always related to predisposing risk factors (mainly intravenous catheters). In the presence of a serious baseline disease, the initial critical clinical condition and inadequate empirical treatment are the main prognostic factors associated to greater mortality.

Objective: To determine the usefulness of diagnostic tests performed before a second look laparotomy in patients with epithelial ovarian cancer., Study Design: Thirty-three patients with epithelial ovarian cancer attended at Fundación Jiménez Díaz from 1984 to 1995 were studied. All patients initially underwent cyto-reducing surgery, followed by at least six platinum-based chemotherapy cycles. Prior to second look laparotomy all patients were evaluated by computerized tomography (CT) of the pelvis and abdomen, CA-125, pelvic-abdominal echography and gynecologic examination. To evaluate sensitivity, specificity, positive predictive value and negative predictive value for each test contingency tables were used., Results: Eleven out of the 33 second look patients (33%) had histologic or cytologic evidence of disease. Six out of the eleven positive second look had a positive CT prior to second look (sensitivity of 55%). CT showed lack of disease in 21 out of the 22 negative second look cases (specificity 95%). Positive and negative predictive values of the test were 86% and 81%, respectively. Nine cases out of the 28 who had a CA-125 obtained had a positive second look. Four out of these nine patients had an increased CA-125 value (sensitivity 44%, specificity 95%, positive predictive value 80% and negative predictive value 78%). Sensitivity, specificity, positive predictive value and negative predictive value of physical examination and echography were 36%, 100%, 100%, 76% and 27%, 95%, 75%, 72%, respectively. On the other hand, sensitivity, specificity, positive predictive value and negative predictive value of all tests taken together were 64%, 91%, 78% and 83%, with a rate of false-negative results of 17% and a rate of false-positive results of 22%., Conclusion: Pelvic-abdominal computerized tomography, CA-125, pelvic-abdominal echography and gynecologic examination can be an alternative to second look laparotomy for the diagnosis of persistence or recurrence of the disease in patients with epithelial ovarian cancer.

A study was conducted to know the rate of non-compliance of antituberculosis therapy among HIV-infected patients, the factors associated with non-compliance and the evolution of these patients. The therapy compliance in 276 tuberculous HIV infected patients diagnosed in two Madrid hospitals was analyzed. Fifty-one patients (18%) were not included in the analysis (6 died without therapy, 6 were lost and 39 died during therapy). Out of the 225 evaluable patients, 36 (16%, 95% CI, 11.6-21.6) did not comply with therapy. The only factor associated with a higher therapy non-compliance was the antecedent of drug use (20% of non-compliance; relative risk: 10, 95% CI, 1.4-71). Patients using drugs at tuberculosis diagnosis had higher risk for non-compliance (31%; RR, 3.1; 95% CI, 1.6-6.3). The incidence of tuberculosis reactivation after leaving therapy was 78.8/100 patient-years. Therapy non-compliance increased death risk associated with tuberculosis (RR, 9.8; 95% CI, 4.6-21). Programs for controlling antituberculous therapy should give priority to active drug users, as this is the group with the highest risk for non-compliance.

Objective: To review the clinical, diagnostic, therapeutic and prognostic characteristics of cutaneous diseases caused by atypical mycobacteria and more specifically those by Mycobacterium chelonae. To improve our knowledge of this disease and its differential diagnosis with other cutaneous infections associated with folliculitis., Design: Retrospective descriptive study., Setting: Primary care and Dermatology specialty in a Health Center in the Madrid metropolitan area., Patients and Other Participants: The clinical records of non immunosuppressed patients, with multiple cutaneous lesions caused by Mycobacterium chelonae and confirmed by culture were reviewed. The evolution time, treatment regimes before diagnosis and possible epidemiological factors were studied., Measurements and Main Outcomes: Culture confirmed three non immunosuppressed patients with multiple lesions in both legs. Lesions had been present for longer than two months and had been treated with topical and systemic antibiotics with no improvement. The only relevant epidemiological finding was wax depilation., Conclusions: It is important to know the existence of this type of infection, since diagnostic suspicion allows for an early and efficient therapy which will present the emergency of important scars.

Objectives: To analyze the effect of high purity factor VIII concentrates on CD4+ cell counts in HIV-seropositive hemophiliac patients., Patients and Methods: A study was conducted with 16 HIV seropositive patients with severe hemophilia A (mean age: 20 years) free from anti-retroviral therapy and with CD4+ cell counts higher than 200/microliters who had their intermediate purity factor VIII concentrates changes to high purity concentrates immunoadsorbed with monoclonal antibodies (monoclonal FVIII). For each patient two consecutive period were compared, one before (median: 21 months) and the other after (median: 19 months) the therapeutic change. All patients had three or more CD4+ cell counts determined in each period, which were used to calculate the slope with time (CD4+/microliters/month and % variation/month). The Wilcoxon test was used for statistical comparisons among paired tests., Results: No significant differences were observed among the mean values of the initial (656 +/- 246/microliters), change time (625 +/- 277/microliters) and final counts (493 +/- 246/microliters). During the intermediate purity period slopes (mean: -0.6 +/- 12 CD4+/microliters/month) were not significantly different from zero. In contrast, they were significant during the period of treatment with monoclonal FVIII (mean: -8.5 +/- 14 CD4+/microliter/month; p < 0,05). Nevertheless, differences between the slopes of the two periods were not statistically significant., Conclusion: In contrast with the results obtained in prospective studies, no favorable effect of monoclonal FVIII on CD4+ cell counts was observed among HIV-positive hemophiliac patients.

Lyme's disease (LD) is a multisystemic infection due to Borrelia Burgdorferi transmitted through the byte of a vector arthropod of the Ixodes genre. Until now we do not know exactly which is the geographical distribution in our setting, no case have been published in the Aragon Community. We present four patients diagnosed of Lyme's disease following clinical and serological criteria (IFI) according to the recommendations of the Spanish Group for the study of Lyme's disease. A patient with Chronic Migratory Erythema (ECM); two others in stage II--one with predominant dermal lesions and other with predominant neurological symptoms--and finally, a patient in stage III with polyarticular symptoms and with antecedent of having showed a lymphocytic meningoencephalitis.

Idiopathic retroperitoneal fibrosis (IRF) is a disease difficult to diagnose. It is considered by different authors of autoimmune origin given its similarity to other connective tissue diseases. We present the case of a female patient diagnosed by a postmortem study, of IRF with multiorgan involvement (lymph nodes, serose tissue, liver, spleen, adrenal glands, thyroid and kidneys) and atypical presentation, not finding other similar cases in the national literature.

Bilateral diaphragmatic paralysis is characterized by severe dyspnea in decubitus, with or without known respiratory or cardiac disorders. In both patients clinical diagnosis was confirmed by measuring the transdiaphragmatic pressure which was approximately zero. The first patient, previous to the clinical onset, had an episode of gastroenteritis and later developed a pneumonia; in the second patient, clinical manifestations started after neck surgery and both the clinical and functional disorders recovered within the following eight months.