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Mesa redonda apresentada no Simpósio Internacional sobre Doença de Hodgkin, realizado no Instituto Nacional de Câncer no Rio de Janeiro — 16 a 20 de Janeiro de 1967. Transcrição da gravação não revista pelos autores.

Objective: to detect the incidence of postoperative delirium in critically ill patients admitted to a surgical intensive care unit and to evaluate the predisposing and precipitating factors associated with postoperative delirium in critically ill patients admitted to a surgical intensive care unit., Method: this is a prospective cohort study of 157 critically ill surgical patients. Fisher's exact test and Chi-square test were used for the association between factors and the occurrence of delirium, the Wilcoxon test for numerical variables, and the logistic regression model for the analysis of predisposing and precipitating factors., Results: the incidence of delirium was 28% (n=44). Age was a significant predisposing factor (p=0.001), followed by the length of surgery (p<0.001), blood transfusion (p=0.043), administration of crystalloids (p=0.008), and anti-inflammatory drugs (p=0.037), which were the precipitating factors identified. The best-adjusted models were: age, length of surgery, non-administration of anti-emetics, use of sufentanil, and blood transfusion., Conclusion: delirium is a frequent condition in critically ill adults undergoing surgery and the existence of precipitating and predisposing factors is relevant to the outcome, with the anesthetic-surgical procedure as the catalyst event.

ABSTRACT Objective: To analyze the factors involved in nursing care that are related to the safety culture of chronic renal patients on hemodialysis. Method: Integrative literature review, carried out through the steps: problem identification, bibliographic research, data evaluation, data analysis, and report. We adopted the guiding question: “What scientific evidence is there about the factors related to the safety culture in hemodialysis clinics, according to the nursing team?” The search was carried out in the LILACS, Medline / PUBMED, Scopus, CINAHL, Cochrane, and Web of Science (WOS) databases. Results: The sample of this review was composed of five studies. The factors found were: 8 predisposing, 13 disabling, 11 precipitating, and 18 reinforcing. Conclusion: The analysis of literary productions allowed an understanding of the main factors linked to nursing practices that influence the safety culture of patients on hemodialysis.

Resumo OBJETIVO Descrever os fatores precipitantes de descompensação da insuficiência cardíaca entre pacientes aderentes e não aderentes ao tratamento. MÉTODOS Estudo transversal de uma coorte multicêntrica. Pacientes acima de 18 anos com insuficiência cardíaca descompensada (classe funcional III/IV) foram elegíveis. Para a coleta dos dados foi utilizado um questionário estruturado avaliando os motivos da descompensação. O uso irregular de medicação prévio à internação, controle inadequado de sal e líquidos foram considerados como grupo de má adesão ao tratamento. RESULTADOS Foram incluídos 556 pacientes, com idade média de 61±14 anos, 362(65%) homens. O principal fator de descompensação foi a má adesão, representando 55% da amostra. Os pacientes que referiram o uso irregular das medicações na última semana apresentaram 22% mais risco de internação por má adesão quando comparados aos pacientes aderentes. CONCLUSÃO O estudo EMBRACE demonstrou que em pacientes com insuficiência cardíaca, a má adesão mostrou-se como o principal fator de exacerbação.

Schizophrenia is a multifactorial disease with high genetic heterogeneity and complex inheritance. In Boyacá, Colombia, we studied a group of 20 schizo- phrenic patients (16 men and four women) in order to establish their socio-demographic and clinical characteristics, and the genetic and predisposing factors. Cytogenetic studies and a descriptive anal- ysis of qualitative and quantitative variables were done. More often the disease started in young adults (average age of initiation: 22.5 years). The predomi- nant subtype (8/20) was paranoid schizophrenia, with progressive start (14/20). Predisposing factors were found in 15 patients, namely: physical in nine, social in five and economic in one. All cariotypes were normal. Clinical features did not associate with either the sociodemographic characteristics or the genetic and predisposing factors; this is evidence of the clinical heterogeneity of schizophrenia. Patients and their families received genetic counseling and explanations on the results, the possibility of recur- rences and the risk of suffering the disease when a relative is affected by it. Further and larger studies are required in order to determine if the factors eval- uated in this work have influence on the develop- ment of the disease.

Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution.El error de medicación se define como cualquier error en el proceso de prescripción, dispensación o administración de una medicación, pudiendo o no traer consecuencias serias. En este estudio, de carácter descriptivo y exploratorio, son evaluados cuatro escenarios con situaciones de práctica de enfermería. El grupo profesional fue constituido de 256 personas y fueron estudiados 89 cuestionarios. Fueron comparadas las respuestas dadas por los enfermeros con las de técnicos y auxiliares de enfermería que deberían opinar si las situaciones representaban o no un error de medicación, si había necesidad de notificación al médico o de completar un informe de ocurrencias. Los resultados demostraron una uniformidad en las respuestas, que traducían dudas si la situación era un error o no, y cuales medidas deberían ser tomadas, evidenciando la necesidad de discutir el tema dentro de las instituciones.O erro de medicação é definido como qualquer erro no processo de prescrição, dispensação ou administração de medicamentos, podendo ou não trazer conseqüências adversas. Neste estudo, de caráter descritivo e exploratório, são avaliados quatro cenários, com situações da prática de enfermagem. O grupo profissional foi constituído por 256 pessoas e foram analisados 89 questionários. Foram comparadas as respostas dadas pelos enfermeiros com as dos técnicos e auxiliares de enfermagem nas quais deveriam opinar se as situações representavam ou não um erro de medicação, se havia necessidade de notificação ao médico e do preenchimento de um relatório de ocorrências. Os resultados demonstraram uniformidade nas respostas, que traduziam dúvidas se a situação era um erro ou não e quais medidas deveriam ser tomadas, evidenciando a necessidade de discutir o tema dentro das instituições.

Se informa un brote de histoplasmosis ocurrido en los integrantes de una familia y que comprometió a cuatro personas, dos mujeres, una niña y un hombre. El caso índice consultó por sintomatología respiratoria grave, de comienzo súbito, que requirió hospitalización. En los otros casos, la infección cursó de manera asintomática pero se puso en evidencia por la reactividad en las pruebas serológicas con histoplasmina. La búsqueda de una fuente común de contagio llevó a sospechar que era la tierra de un vivero que se había utilizado como fertilizante de las plantas caseras. Las suspensiones de las tierras de las macetas sirvieron para inocular ratones BALB/c, de cuyos órganos fue posible aislar el agente etiológico, Histoplasma capsulatum var. capsulatum. Si bien la histoplasmosis es más frecuente en ciertas ocupaciones y es propia de áreas rurales, las epidemias y los brotes son ahora comunes en áreas urbanas debido a actividades como la urbanización masiva, la tala de árboles, las demoliciones y el uso de tierras enriquecidas con abonos orgánicos (gallinaza, guano). Se llama la atención sobre el peligro que representa esta última actividad.

Con el objetivo de conocer los aspectos epidemiológicos, factores contribuyentes y precipitantes, así como tratamiento previo de los pacientes de la Consulta Especializada de Asma Bronquial, se revisaron las historias clínicas de 275 personas atendidas en el período comprendido entre abril de 1994 y abril de 1996. Se analizaron las variables demográficas, factores desencadenantes y aspectos terapéuticos. Las mujeres constituyeron el 90,18 % de la muestra, el promedio de edad fue de 33 años, con un tiempo promedio de evolución de la enfermedad de 21 años. El 84,3 % de los pacientes tenía antecedentes atópicos familiares; el 15,7 % no presentaban factores contribuyentes, mientras el 100 % reconocía algún factor precipitante de sus crisis. El 45 % de la muestra no llevaba tratamiento intercrisis y la deficiente educación sanitaria sobre la enfermedad se observó en el 60 %. Los resultados obtenidos mostraron que nuestros pacientes tenían desencadenantes similares a los observados en la literatura, el tratamiento intercrisis era irregular y no siempre se acompañaba de medicamentos antiinflamatorios. Se identificaron 15 aspectos que resumían las características de estos enfermos y facilitaban su enfoque clínico y terapéutico.With the purpose of knowing the epidemiological aspects, the contributing and precipitating factors, as well as the previous treatment of the patients from the Bronchial Asthma Outpatient Service, the case histories of 275 persons treated in the period between April 1994 and April 1996, were reviewed. The demographic variables, the unchaining factors, and the therapeutical aspects, were analyzed. Women made up the 90,18 % of the sample; the average age was 33 years, with 21 years as average evolution time for the disease. The 84,3 % of the patients had familiar atopic backgrounds; 15,7 % did not present contributing factors, while the 100 % recognized some precipitating factor of their crisis. The 45 % of the sample had no intercrisis treatment, and a deficient sanitary education about the disease was observed in 60 %. The results showed that the patients had unchaining factors similar to those observed in the literature, the intercrisis treatment was irregular, and not always carried antiphlogistic drugs. Fifteen issues were identified; such outlined the characteristics of these patients, and made easier the clinical and therapeutic approach.

El principal objetivo de este trabajo es conocer la prevalencia de la psoriasis en menores de 16 años inclusive, en relación al total de las consultas por dicha patología, en el servicio de dermatología del hospital Pediátrico del Niño Jesús, en el período comprendido entre Julio de 2008 y Agosto de 2009. Durante este período se atendieron 5753 consultas dermatológicas, entre niños y adultos, ya que en dicho servicio se atienden todos los grupos etarios. De 5753 consultas dermatológicas, 115 pacientes correspondieron a psoriasis, de los cuales 26 eran menores de 17 años. Se estudiaron retrospectivamente 26 niños entre los 3 meses y 16 años. Siendo las mujeres las más afectadas con una relación mujer-hombre de 4,2:1. El grupo etario más afectado fue entre los 9 y 13 años. Los factores desencadenantes, tanto externos como sistémicos, pueden inducir la psoriasis en individuos predispuestos genéticamente. En nuestro trabajo las infecciones se observaron en 8 pacientes (30,77%), el estrés psicógeno y los fármacos fueron observados en 2 casos cada uno (7,7%). La forma clínica mas observada fue la vulgar o en placas en 12 pacientes (46,15%) y la "guttata", siendo el prurito el síntoma más común en 18 (69,23%). El 88,46% de los casos fueron tratados exitosamente con terapéuticas tópicas y solo el 11,54%, requirió tratamientos sistémicos específicos para la entidad Se concluye que la prevalencia en relación al total de las consultas de psoriasis, en este lapso y en este hospital, fue del 22,6% para este grupo etario.The main objective of this study was to determine the prevalence of psoriasis in children less than 16 years including in relation to the total number of consultations for this disease in the dermatology service at Pediatric Hospital "Niño Jesus", since July 2008 to August 2009. During this period of time 5753 dermatological consultations were attended, children and adults as well. In 5753 dermatological consultations, 115 were for psoriasis patients, of whom 26 were under 17. We studied 26 children between 3 months and 16 years. Women being the most affected with a female man 4,2: 1. The most affected age group was between 9 and 13. The precipitating factors, both external and systemic, may raise psoriasis in predisposed individuals from the genetic standpoint, in this study infections were observed in 8 patients (30.77%), psychogenic stress in 2 of them (7, 7%), and drugs also in 2 (7.7%) The clinical variant most common were the vulgar-plaques and guttate in 12 patients (46.15%) and pruritus the most common symptom in 18 (69.23%). The 88.46% of the cases were successfully treated with topical treatment and only 11.54% required more aggressive treatment. We conclude that this age group is frequently affected by psoriasis with prevalence in relation with total visits for the pathology of 22.6%. In the future, it will be interesting to investigate more deeply childhood psoriasis in our city due it important prevalence and to correlate the findings with other local or international studies.

Objective: To evaluate differences between the detection of incidents or adverse events (I/AE) using a Trigger Tool (TT) and voluntary notification platform (SNEA)., Methods: The study population is the working population attended on an outpatient basis in an Insurance Company ("mutua") from January to September 2016. The cases declared as Incident or Adverse Event (I / AE) were selected through the SNEA (21 cases), according to whether the event has not affected the patient or on the contrary has affected him. On the other hand, 20 clinical histories per month were randomly selected where the TT was applied(180 cases). The 201 clinical histories were reviewed looking for the existence of triggers. The agreement between the SNEA system and the TT was evaluated using proportion of positive agreement (I/EA), proportion of negative agreement (not I/EA) and Kappa index., Results: TT detected I/EA cases in 41.3% of the revisions while the SNEA was 10.3% (p<0.001). The Kappa index showed a low concordance value (Kappa = 0.12), which indicates the small coincidence of I/EA detected by both systems. The proportion of negative agreement was greater than that of positive agreement (74.5% versus 26.9%). The SNEA system detected less I/ EA and above all it deals with fewer incidents. On the contrary, the TT system detected a greater number of I EA and especially EA., Conclusions: Trigger Tool is a recommended tool for the detection of incidents or adverse events that can complement the one obtained through voluntary notification platform in the reality of a "mutua"., (Copyright belongs to the Associació Catalana de Salut Laboral.)

Introduction: Suicidal ideation refers to thoughts that range from a vague idea of committing suicide to a specific suicide plan., Objective: To explore factors such as demographic, social, family, abuse, risk of depression, habits and health conditions, which influence suicidal ideation in the elderly people in the cities of Medellín, Barranquilla, and Pasto (Colombia), with the intention to identify those associated factors that can be used in public health programs focused on this population., Methods: Cross-sectional analytical study was conducted using a secondary source, demographic, social, clinical variables, social support, discrimination, abuse, happiness, depression, functional capacity, and as a dependent variable were asked the question: "Have you ever thought about committing suicide?" A descriptive, bivariate and multivariate analysis was performed., Results: The median age was ≤ 69 [interquartile range, 11] years, and 58.2% were women. The prevalence of suicidal ideation was 6.4%, and of these, 28.7% had made plans to end their lives, and 66.7% had tried at least once. A statistical association was found with informal employment, cigarette consumption, alcohol and psychoactive substances, risk of depression, having a disability, dissatisfaction with their quality of life, with their health, with their economic situation, as well as feeling unhappy, bad treatment and bad relationships among family members, poor social support, sexual and economic abuse, and finally, discrimination., Conclusions: Suicidal ideation in older adults in three cities of Colombia is explained by the sexual and economic abuse that this population is suffering, as well as bad personal relationships between the members of the family of the older adult. The risk of depression increases the probability of having thoughts against one's life., (Copyright © 2018 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To explore whether episodes of exposure to atmospheric Saharan dust is a risk factor for hospitalization in patients with acute heart failure (AHF) attended in a hospital emergency department (ED)., Methods: Single-center retrospective study of patients with AHF. The cohort was analyzed in 2 groups: ED patients hospitalized with AHF and patients discharged home from the ED. Air pollution on the 5 days leading to ED admission for AHF was recorded as the average concentration of breathable particulate matter with an aerodynamic diameter of no more than 10 µm (PM10) in the following ranges: fine PM (diameter less than 2.5 µm) or coarse PM (diameters between 2.5 and 10 µm). High Saharan dust pollution exposure was defined by mean daily PM10 concentrations between 50 and 200 µg/m3. Multivariable analysis was used to estimate risk for AHF in relation to PM10 exposure in the 5 days before the ED visit., Results: A total of 1097 patients with AHF were treated in the ED; 318 of them (29%) were hospitalized and 779 (71%) were discharged home. Hospitalized patients were older, had more concomitant illnesses, and more episodes of exposure to Saharan dust (P < .0001). Multivariable analysis confirmed the association between Saharan dust exposure and hospital admission in these patients (odds ratio, 2.36; 95% CI, 1.21-4.58; P = .01)., Conclusion: In the absence of prospective studies, the results of this series suggest that exposure to high levels of Saharan dust (PM10 concentrations between 50 and 200 µg/m3) may be a precipitating factor for hospitalization in AHF episodes.

OBJETIVO: O objetivo do presente trabalho é avaliar retrospectivamente as características e o resultado do tratamento de 15 casos de corpo estranho de natureza têxtil retido na cavidade abdominal após diferentes tipos de operações. MÉTODO: Analisamos retrospectivamente os dados demográficos de 15 pacientes com diagnóstico de gossipiboma tratados no Hospital Universitário Gaffrée-Guinle no período de janeiro de 1987 a janeiro de 2007. RESULTADOS: Onze pacientes (73%) eram mulheres e quatro eram homens (27%), com mediana da idade de 50 anos. As operações prévias foram de natureza ginecológica (40%), gastrointestinal (27%), urológica (13%), obstétrica (13%) e oncológica (7%). Dois deles haviam sido submetidos a tratamento cirúrgico de urgência. O intervalo de tempo entre a operação primária e o diagnóstico definitivo variou de uma semana a 50 meses, com mediana de oito meses. A queixa preponderante foi dor associada ou não a tumoração abdominal e obstrução intestinal. O problema foi confirmado pela tomografia computadorizada em 12 oportunidades. Todos os pacientes tiveram o corpo estranho removido. As taxas de morbidade e mortalidade pós-operatórias foram respectivamente 26,6% e 0%. CONCLUSÕES: Houve predomínio de mulheres e o tipo de operação que mais contribuiu foi a de natureza ginecológica. A hipótese de gossipiboma deve ser aventada sempre que há operação prévia e queixas incompatíveis com a evolução usual. A tomografia computadorizada foi importante para corroborar o diagnóstico. A identificação de fatores de risco para retenção de corpo estranho só foi possível num pequeno número de casos de nossa amostragem. Apesar da elevada taxa de morbidade pós-operatória, a evolução foi satisfatória e sem mortalidade. A prevenção somente será efetiva se adotadas regras rígidas de controle com observância rigorosa das mesmas, aliadas ao treinamento apropriado de toda a equipe cirúrgica.

Objectives: Acute heart failure (AHF) has become a public health problem of the first magnitude: it is the main cause of emergencies and hospitalization in patients over the age of 65. Various guidelines for managing AHF have been drafted in recent years, yet we continue to see high readmission and mortality rates. The emergency department is where patients with AHF should be diagnosed and stabilized, and their clinical picture established. A next step would be to identify the factors that may have led to the acute event so that it can be managed optimally. Few studies have analyzed precipitating factors in AHF and their role in prognosis. This review analyzes the prevalence of precipitating factors and their relation to readmission and mortality.

Background: Chronic Fatigue Syndrome (CFS) is a complex and multifactorial disease. Stressful situations experienced could be related to the presentation of the disease. Few studies have determined which factors could trigger CFS. The main objective of this study was to explore the stressful situations which can be associated with CFS presentation., Methods: Retrospective observational case-control study with CFS diagnosed patients according to the Fukuda's criteria. Controls were matched to cases by sex, age and educational level with a 1:1 ratio. Participants aged between 18 and 75 years from the province of Lleida. Information was obtained through personal questionnaires. The measure of association was the odds ratio., Results: In total, 77 cases and 77 controls were included. Association found between stressful life events and presentation of disease were pregnancy ORa=31.7 (CI95%:2.2-456.7), spousal abuse ORa= 10.2 (CI95%:1.2-88.4) and mobbing ORa=6.9 (CI95%:1.3-36.9), eating disorders=7.5 (CI95%:1.3-42.1), car accident ORa=5.5 (CI95%:1.7-17 9), economic problems ORa=5.1 (CI95%:2.1-12.6) and changes in sleep habits ORa=2.8 (CI95%:1.1-7.5)., Conclusions: Stressful life events as pregnancy, spousal abuse, mobbing, eating disorders, car accident, economic problems and changes in sleep habits felt by those affected must be taken into consideration when compiling background information related to the onset of Chronic Fatigue Syndrome. Adequate identification of these stressful life events in risk people could contribute to early diagnosis of Chronic Fatigue Syndrome.

Introduction: Delirium is the most prevalent neuropsychiatric syndrome in the general hospital. Its presence is a marker of poor prognosis for patients. Its prevention could be the most effective strategy for reducing its frequency and its complications., Objective: To review recent findings and strategies for the prevention of delirium., Methodology: A non-systematic review of scientific articles published in the last ten years in Spanish and English. A search was made in databases such as MEDLINE, Cochrane, EMBASE, Ovid, and ScienceDirect, for articles that included the terms, delirium and prevention., Results: Identification of predisposing and precipitating factors for delirium and a better understanding of the pathophysiological mechanisms underlying the onset of delirium have enabled the implementation of various pharmacological and non-pharmacological strategies in patients at high risk to develop hospital delirium. The studies to prevent delirium have focused on surgical patients. The current evidence supports the daily implementation of non-pharmacological measures to prevent delirium, as they are easy and cost effective. The available evidence is still limited to recommend the daily use of pharmacological strategies in delirium prophylaxis, and there is a consensus against the modest use of antipsychotic drugs in surgical patients and dexmedetomidine in patients in intensive care., Conclusions: New high-quality clinical trials and studies involving non-surgical patients are needed to provide more evidence about this subject., (Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

Objective: To evaluate the precipitating factors (PF) associated with acute heart failure and their association with medium-term prognosis., Patients and Methods: Multipurpose prospective study from the EAHFE Registry. We included as PF: infection, rapid atrial fibrillation (RAF), anaemia, hypertensive crisis, non-adherence to diet or drug therapy and non-ST-segment-elevation acute coronary syndrome (NSTEACS). Patients without PF were control group. Hazard ratios (HR) crudes and adjusted for reconsultations and mortality at 90 days were calculated., Results: 3535 patients were included: 28% without and 72% with PF. Patients with RAF (HR 0.67; 95%CI 0.50-0.89) and hypertensive crisis (HR 0.45; 95%CI 0.28-0.72) had less mortality and patients with NSTEACS (HR 1.79; 95%CI 1.19-2.70) had more mortality. Reconsultation was fewer in patients with infection (HR 0.74; 95%CI 0.64-0.85), RAF (HR 0.69; 95%CI 0.58-0.83) and hypertensive crisis (HR 0.71; 95%CI 0.55-0.91). These differences were maintained in all the adjusted models except for hypertensive crisis., Conclusions: One PF is identified in 3 out of 4 patients and it may influence medium-term prognosis. At 90 days, NSTEACS and RAF were associated with more and less mortality respectively, and RAF and infection with less probability of reconsultation., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

The verification of the occupational origin of a disease is a forensic medical activity requiring: the confirmation of the existence and of the exact nosographic identification of the disease, as well as the type of work really performed, and the actual exposure to an effective occupational hazard during an adequate time, and finally a reconstruction of the causal relationship based on objective data. Checking the disease is essentially documentary, corroborated by direct survey by medical examination. The assessment of exposure to the occupational hazard must be scrupulous also, not being acceptable the medical history alone: that is, it does require documentary evidence. Finally, the logical process of recognition of causation requires the application of rigorous forensic medical methodology, with references to current scientific knowledge, and the application of legal criteriology from the legal field of law in which you are moving. Indeed, forensic medical methodology is not the same of epidemiological one: probability of occurrence of an event is not a proof, but only a circumstantial element. A forensic medical doctor organizes every evidence and circumstantial evidence in a unique decision-making process, as a result of a logical process, and probabilistic data can be among circumstantial evidence, but they must suit the case in details, in order to reach the so called "logic probability". But this doesn't mean that you have "proven" the occupational origin of a disease. In the "demonstration" of a fact you use the same forensic medical methodology (thus referring to classic criteria: temporality, biological gradient and plausibility, topographical, exclusion, and phenomenal continuity if suitable, too), and also the same general scientific references, nevertheless the law can be different in causality principles admitted (the principles governing the causal link are the same in Criminal Code and Civil law both, but they differ in private insurance), and besides there is a different rule of evidence, that is the "quantum of evidence" required (the amount of evidence needed) and, secondarily, also a different quality of proof required (how reliable such evidence should be considered, and which types of evidence admitted). Therefore in Civil law you can reach a "procedural truth" different from the one in Criminal law, and various from the one needed to prevail in litigation with social security insurance or with private insurance.

Acute heart failure episodes, whether onset or decompensation of a chronic form, are most often precipitated by a concurrent process or disease, described as precipitating factors of heart failure. In this article, we review these precipitating factors, their proportions and clinical relevance in general and in subgroups of patients, their relationship with prognosis, and their possible prevention., (Copyright © 2014 Elsevier España, S.L. All rights reserved.)

Introduction: Patients with migraine often report factors or circumstances that precipitate or trigger their attacks. Yet few studies have been conducted to examine this matter., Aim: To explore the factors that precipitate migraine in our setting, as well is their possible relation with the intensity of the attacks or the overall repercussion of migraine., Patients and Methods: An epidemiological, cross-sectional, multi-centre study was conducted in neurology consultation services. Sociodemographic and clinical data were collected and the precipitating factors were identified from a closed list. The specific migraine disability questionnaire -Headache Impact Test (HIT-6)- and the measurement of the number of lost workday equivalents were used in the study., Results: Altogether 817 patients were recruited (72.5% females, mean age: 34.6 ± 10.3 years). A total of 70.5% of the patients had severe disability according to the HIT-6. The mean monthly number of lost workday equivalents was 2.1 ± 2.5. A total of 96.6% of the patients identified some precipitating factor for the attacks, the most commonly reported being hormonal (75.2%), stress (70.9%) and those related with disorders affecting sleep patterns (68.4%)., Conclusions: The FACTOR study confirms that most patients with migraine identify some circumstance that precipitates their attacks. Controlling or avoiding these factors, whenever possible, must be part of the programme of education received by patients suffering from migraine.

Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized., Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals., Patients and Methods: Prospective registry of 14 centers. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered., Results: Three hundred seventy two patients aged 69 +/- 13 years old, 59% men, were assessed. The main etiologies of HF were ischemic in 31.6%, hypertensive in 35.2%, valvular in 14.9% and idiopathic in 7.4%. There was a history of hypertension 69%, diabetes in 35%, myocardial infarction in 22%, atrial fibrillation (AF) in 28%. The presentation form of HF was chronic decompensated in 86%, acute in 12%, refractory in 2%. The causes of decompensation were non compliance with diet or medical prescriptions in 28%, infections in 22% and AF 17%. ECG showed AF in 36% and left bundle branch block in 16%. Echocardiography was performed in 52% of the patients, 69% had left ventricular ejection fraction <40%. On admission, 39% received angiotensin converting enzyme (ACE) inhibitors, 15% beta-blocker, 25% digoxin, 16% spironolactone and 53% furosemide. The mean hospital stay was 111 +/- 10 days and mortality was 4.5%., Conclusions: The elderly is the age group most commonly admitted to hospital due to HF. The main etiologies were ischemic and hypertensive. The main causes for decompensations were noncompliance with diet or medical prescriptions and infections. A significant proportion had a relatively well preserved ventricular systolic function.

The objective of etiologic research is to look for the causes of disease, their relationships with it, and their relative magnitude on the appearance of the disease. The observational studies (in which there is no manipulation of the study factor), that are performed when the knowledge about the disease to be studied allows to specify beforehand one or more hypothesis that can be tested are called etiologic or analytic studies. The objective of etiologic studies is to identify risk factors for a given disease, to estimate their effects on the appearance of disease, and also to suggest a possible strategy of interventions to diminish the appearance of disease. Case-control and cohort studies are the etiologic studies more often used, characteristics of which will be exposed in this article.

Background: Delirium or acute confusional state is defined as an acute disturbance of consciousness and attention. Its prevalence among hospitalized patients fluctuates between 25 and 60%., Aim: To assess the prevalence and features of delirium in an intermediate care unit., Patients and Methods: All patients admitted to intermediate care unit during a period of two months were assessed and followed. Delirium was assessed daily during the stay in the unit, using the Inouye Confusion Assessment Method. Delirium was classified as hyperactive if the patient required pharmacological or physical restraining methods., Results: Sixty four patients, 32 female, aged 19 to 90 years old were assessed. Forty one percent had delirium. Of these, delirium started after admission in 46% and was hyperactive in 35%. Cognitive disturbances were ascertained by the health care team in 69% of patients with delirium. Age over 70 years old and a history of dementia were defined as predisposing factors for delirium. Serum albumin was > 3.5 g/dl in 14 of 18 patients with and in 11 of 27 patients without delirium (p = 0.04). The most frequent risk factors were systemic infections, metabolic disturbances and intracranial lesions. Physical restraining and neuroleptics were the most commonly used measures to deal with hyperactive patients., Conclusions: The prevalence of delirium found in this study is similar to that reported elsewhere, except for the high proportion of patients whose delirium started after admission.