Medicina
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Patients with neutropenia and fever conform a heterogeneous population with a variable risk of serious complications and mortality. The goal of this study was to identify prognostic risk factors present at the beginning of the episode, for adverse events and serious complications in patients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia and fever (neutrophils < 1000/mm3 and T > 38.3 00) in 167 patients admitted to our general hospital between 1997 and 2004 was followed. ⋯ Significant differences were found in presence of current co-morbidities, body temperature > 39 00, heart rate > 120 beats per minute, respiratory rate > 24 per minute, systolic blood pressure < 90 mm Hg, presence of 3 or more altered laboratory values, presence of a clinical site of infection and positive blood cultures. The logistic regression multivariate analysis showed that the following characteristics were independently associated with adverse events: systolic blood pressure < 90 mm Hg (OR = 7, p < 0.01), current co-morbidities (OR = 8.5, p = 0.02), respiratory rate > 24 per minute (OR = 2.8, p = 0.01), and the presence of a clinical site of infection (OR = 2.1, p = 0.03). The presence of systolic hypotension, high respiratory rate, current co-morbidities and a clinical site of infection at the time of admission were identified predictors of subsequent serious complications in patients admitted with fever and neutropenia in a general ward.
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Pulmonary disease, due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlying other diseases. In our country, there is no updated information on the prevalence of this pulmonary disease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary disease due to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment and evolution.
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Campylobacter is an important agent of illness in human beings. Bacteremia occurs principally in the immunocompromissed host and is frequently due to C. fetus. ⋯ We refer two cases of patients with severe enteritis and bacteremia, both of them with immunosupressive concomitant diseases such as nephrotic syndrome and chronic cirrotic hepatopathy. Both patients presented hemathemesis.
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Three frequent problems of daily medical practice are analyzed: (1) a physician's perceived obligation to provide medical services regardless of whether one's health care institution provides monetary compensation for the medical act, (2) increasing pressures to obtain informed consent in a national context where paternalistic physician-patient interactions have been customary, and (3) a physician's professional responsibility to offer internationally recognized standard of care even if this means allocating expensive tertiary healthcare resources to a small number of patients in spite of one's knowledge that national governments are unable to provide primary care to millions of their citizens. These problems are discussed from the point of view of the ethical principle of respect for patient autonomy. ⋯ Physician leaders, health care institutions, and professional organizations are responsible for creating an environment in which doctors can discuss ethical issues as comfortably and as frequently as they discuss biological matters. Health care providers should do their best to recover the human side of medical practice which, undoubtedly, would create a greater likelihood that appropriate decisions will be made when facing complex ethical dilemmas.
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The hantaviruses are a group of emerging rodent-borne pathogens (family Bunyaviridae; Genus Hantavirus) that are etiologic agents for hemorrhagic fever with renal syndrome (HFRS) in Europe and Asia and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. HFRS is associated with rodents of the family Muridae, subfamilies Murinae and Arvicolinae; HPS is associated with rodents of the subfamily Sigmodontinae. Since the identification of HCPS in USA in 1993, a large number of cases of HPS and an increasing number of hantaviruses and rodent reservoir hosts have been identified in Central and South America. ⋯ The factors involved in the dynamics of these viruses in nature, their establishment and transmission within host populations and from hosts to humans, and the variable pathology of these viruses in humans are complex. It is likely that more hantaviruses will be described in the future, and much more data will be required in order to describe the diversity and evolution of this group of pathogens. Latin America, as the center of diversity for Sigmodontine rodents and their hantaviruses is presented with the unique opportunity as well as the challenge of being center stage for continued studies of the dynamics of hantaviruses in natural host populations and the links of host and virus to human populations.