Search

The aim of this study was to determine the clinical significance ofStreptococcus salivariusisolates recovered from blood cultures and compare them with isolates ofStreptococcus bovisbiotypes I and II. Seventeen of the 52 (32%)S. salivariusisolates recovered were considered clinically significant, compared with 62 of the 64 (97%)S. bovisisolates (p<0.0001). Bacteremia caused byS. salivariusoccurred mostly in patients who showed relevant disruption of the mucous membranes and/or serious underlying diseases. Patients withS. salivariusbacteremia were younger than those withS. bovisbacteremia (57 vs. 67 years;p<0.01). Patients withS. salivariusbacteremia and patients withS. bovisII bacteremia had similar rates of endocarditis, colon tumors, and noncolon cancer. On the other hand, when compared withS. bovisI bacteremia,S. salivariusbacteremia was associated with lower rates of endocarditis (18% vs. 74%, respectively) (p<0.01) and colon tumors (0% vs. 57%, respectively) (p<0.005) and higher rates of noncolon cancer (53% vs. 9.5%, respectively) (p<0.01). Bacteremia caused byS. bovisII had a hepatobiliary origin in 50% of the patients, while, in contrast, that due toS. salivariusorS. bovisI was less frequently associated with a hepatobiliary origin (12% and 5%, respectively) (p<0.00001). The rate of penicillin resistance was 31% amongS. salivariusisolates and 0% amongS. bovisisolates (p<0.0001). In conclusion, the clinical characteristics ofS. salivariusbacteremia andS. bovisII bacteremia are similar, and the isolation ofS. salivariusin blood should not be systematically regarded as contamination. [ABSTRACT FROM AUTHOR]

In a prospective study of bacteremia caused by organisms of the Streptococcus milleri group a total of 32 adult patients were observed over a seven-year period. These patients accounted for 1.6% of all patients diagnosed as having significant bacteremia and 17% of all cases of streptococcal (nonpneumococcal) bacteremia diagnosed during the study period. Only five patients had polymicrobic bacteremia. In 31 cases, a presumed origin of infection was identified, generally oral or gastrointestinal disease. There were only six cases of nosocomial acquisition. The most common presenting symptom was prolonged fever. The following forms of presentation were documented: bacteremia with local suppurative infection (56%), bacteremia without local suppurative infection (25%), and endocarditis (19%). An associated focus of infection was found in the abdominal cavity in 20 cases (62%). The mortality rate was 12.5%. All isolates were susceptible to penicillin. Caution is necessary in interpreting a blood culture positive for Streptococcus milleri group organisms, since, unlike other viridans streptococci, they are rarely contaminants. For this reason patients with suppurative processes and/or digestive tract disease must be carefully investigated. [ABSTRACT FROM AUTHOR]

Obesity is one of the non-communicable chronic diseases with the highest increase in recent decades in Latin America, affecting children, adolescents, and especially young adults. Forty percent of adults have a body mass index greater than 25 kg/m2. Numerous studies have demonstrated a relationship between obesity and cardiovascular diseases such as hypertension, coronary artery disease, heart failure, cardiac arrhythmias, diabetes, sleep apnea, and oncological diseases, among others. Weight loss in individuals with overweight and obesity has been shown to reduce the risk of developing comorbidities or improve their progression. Healthcare professionals must initiate patient care by considering their values and treatment goals, facilitating reflection, and fostering responsibility to promote long-term improvements. The initial approach, communication, and physician's attitude during the evaluation of a patient with obesity are significant determinants for successful treatment and patient health. The objective of this document is to compile the available information on the disease and present practical and summarized clinical management recommendations based on scientific evidence.

Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.

Aims: We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate., Methods and Results: A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested., Conclusions: The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF., (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Background : Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods : Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results : Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions : Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases.

Aims: To develop consensus-based recommendations for the management of chronic complex patients with type 2 diabetes mellitus using a two round Delphi technique., Methods: Experts from the Diabetes and Obesity Working Group (DOWG) of the Spanish Society of Internal Medicine (SEMI) reviewed MEDLINE, PubMed, SCOPUS and Cochrane Library databases up to September 2014 to gather information on organization and health care management, stratification of therapeutic targets and therapeutic approach for glucose control in chronic complex patients with type 2 diabetes mellitus. A list of 6 recommendations was created and rated by a panel of 75 experts from the DOWG by email (first round) and by open discussion (second round). A written document was produced and sent back to DOWG experts for clarification purposes., Results: A high degree of consensus was achieved for all recommendations summarized as 1) there is a need to redesign and test new health care programs for chronic complex patients with type 2 diabetes mellitus; 2) therapeutic targets in patients with short life expectancy should be individualized in accordance to their personal, clinical and social characteristics; 3) patients with chronic complex conditions and type 2 diabetes mellitus should be stratified by hypoglycemia risk; 4) age and specific comorbidities should guide the objectives for glucose control; 5) the risk of hypoglycemia should be a key factor when choosing a treatment; and 6) basal insulin analogs compared to human insulin are cost-effective options., Conclusion: The assessment and recommendations provided herein represent our best professional judgment based on current data and clinical experience., (Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Objective: To assess the longterm survival of patients with giant cell arteritis (GCA) in a well defined area in Northwestern Spain., Methods: A followup study of consecutive biopsy proven patients with GCA diagnosed in Lugo, Spain January 1, 1982-March 31, 1996 was performed. Patients were followed from time of diagnosis until either their death or October 1, 1996. Time and cause of death were reviewed. Statistical methods included standardized mortality ratio (SMR), and Kaplan-Meier product-limit survival analysis. Cox proportional hazard models were used to identify clinical features and laboratory findings associated with survival., Results: By October 1, 1996, full information about 109 biopsy proven patients with GCA (59 men/50 women) was available. The mean age +/- SD at the time of diagnosis was 73.9 +/- 7.3 years for women and 74.1 +/- 5.8 for men (p = NS). After a median followup of 54 months, 22 patients (20.2%) had died. Three died within the first month after diagnosis due to either vascular complications related to GCA or therapy complications. Apart from a history of severe underlying diseases (comorbid condition unrelated to GCA), neither sex nor any clinical features of GCA were significantly associated with an increase in mortality. As in the general population of the same age in Lugo, the majority of deaths were due to cardiovascular and cerebrovascular complications. SMR was 0.80 (95% CI 0.47-1.13). One, 2, 5, and 10 year survival rates were 95, 91, 81, and 62%, respectively. Hazard function was 1.8% at Day 30 after diagnosis and remained low until the end of the first year of treatment. Thereafter, mortality increased slightly. As this function was constant, we applied an exponential model. The estimated risk of death with this model was 5.3% per year., Conclusion: Longterm mortality of GCA in our area is low. However, it may be possible to further lower the mortality rate through early diagnosis and careful followup.

The clinical, analytical, evolutive and therapeutic aspects of 33 cases of polycythemia vera which were diagnosed according to the Polycythemia Vera Study Group criteria, are described. Mean age was 65 years with a slight predominance of females (54.5%). Hemorrhagic manifestations were the most frequent (67%) with a great number of patients with digestive manifestations consisting of GI hemorrhage, abdominal pain, portal or suprahepatic veins thrombosis. Splenomegaly was the most frequently found sign upon examination (73%). The mean hemoglobin leukocyte, and platelet levels were 18 g/dl, 16,000 mm3 and 738,000 mm3 respectively. It is note worthy the value of the erythropoietin for the differential diagnosis of secondary erythrocytosis as well as the value of the bone marrow histologic study which should be included in the diagnostic criteria of the disease. The evolution of the process is favorably altered by bleedings and chemotherapeutic cytoreduction which are often performed simultaneously.

11 patients diagnosed as suffering from essential thrombocytosis at "Hospital Xeral de Lugo" between 1978 and 1986, are presented. 7 patients were female and 4 were male with a median age of 63 years. 6 patients had thrombotic manifestation, 6 had hemorrhagic symptoms, 2 had both manifestations and only one had no thrombo-hemorrhagic clinical symptoms. Spleen enlargement was found in 6 cases and liver enlargement in 5. The median count of platelets were 1.585.000 ml; there was no relationship between the amount and their function with the major or minor complications incidence. There was a good response to treatment with hydroxyurea and/or busulfan associated to platelets aggregation inhibitor in some cases. 4 patients died, all of them due to thrombotic complications.