Treatment of Human Brucellosis — Review of Evidence from Clinical Trials

Unresolved issues remain surrounding the treatment of human brucellosis. The present work aims to provide useful information to help clinicians make decisions when treating brucellosis patients. Information based on scientific evidence from clinical trials published over the past 30 years has been compiled and presented in an updated form, covering both focal and non-focal, or uncomplicated, human brucellosis. This chapter shows that, despite the studies published in recent years, areas such as the role of monotherapy or treatment in cases of focal disease, have not been adequately addressed in clinical trials, and demonstrates the need for further research

Thymic Carcinoma Associated with Cerebellar Degeneration

We present the case of a 57-year-old man with ataxia and clinical and radiological features of cerebellar degeneration. A computed tomography showed a mediastinal mass. The patient was diagnosed of thymic carcinoma. paraneoplastic cerebellar degeneration is an unfrequent disorder, and its association with thymic carcinoma is very rare

Calidad de vida y adherencia al tratamiento en pacientes con enfermedad de Parkinson

Quality of life and adherence to treatment are parameters of high relevance in those patients with chronic diseases. The aim of this study was to ascertain the quality of life and adherence to treatment of Parkinson’s disease patients. To this end, we performed a cross sectional study in patients diagnosed with Parkinson’s disease who belong to one of Albacete’s associations of patients and their families. The PDQ-39 and Morisky-Green questioners were used to determine the quality of life and adherence to treatment for a sample of 95 patients. Our data showed an average score of 33.47% in the PDQ-39, being the worst score domains mobility and bodily discomfort. On the other hand, a 31.6% of the patients were classified as adherent to treatment. The main factor associated with adequate adherence is the importance given to the medication by the patient. We found no association between adherence and quality of life.La calidad de vida y la adherencia al tratamiento poseen una gran relevancia en aquellos pacientes que presentan enfermedades crónicas.  El objetivo de este trabajo es conocer y evaluar ambos parámetros, en una población de pacientes de enfermedad de Parkinson. Para ello, se ha realizado un estudio transversal, a través de los cuestionarios de PDQ-39 y de Morisky-Green, en 95 pacientes de la citada enfermedad pertenecientes a alguna de las asociaciones de pacientes y familias de la provincia de Albacete. Los datos muestran una puntuación media de 33,47% en el PDQ-39, siendo los dominios de peor puntuación los referidos a movilidad y malestar físico. Por otro lado, un 31,6% de los pacientes se clasificaron como adherentes al tratamiento. Respecto a este parámetro, constatamos que, el factor principal relacionado con una adecuada adherencia, fue la importancia dada a su medicación por el propio paciente. No se ha encontrado ninguna asociación entre adherencia y calidad de vida

Deep Venous Thrombosis (DVT) in Lower Extremity Amputation as Cause of Pulmonary Embolism

The authors describe the case of a 43-year-old man with a right-leg knee amputation performed 14 years prior. He presented to hospital with dyspnea. A pulmonary embolism was detected. A Doppler ultrasound test showed deep vein thrombosis (DVT), which affected the stump of the amputated limb. When a pulmonary embolism is detected in a patient with an amputated lower limb, an exploration of the stump should be performed to rule out this uncommon complication

Mujer puérpera de 30 años con hipocalcemia severa como debut de la enfermedad celiaca

Hypocalcemia is a common finding in medical practice. The clinical spectrum is highly variable, ranging from an accidental finding to an emergency situation requiring immediate therapeutic measures. Consequently, correct differential diagnosis is essential. We report the case of a 30 year old woman with signs of hypocalcemia and associated tetany as an onset marker of celiac disease. The present case highlights the importance of an accurate diagnosis of celiac disease when considering the causes of hypocalcemia, although it is not very common, especially when associated with tetany.La hipocalcemia es un hallazgo común en la práctica médica. El espectro clínico es ampliamente variable, desde un hallazgo incidental hasta una situación de emergencia que requiere medidas terapéuticas inmediatas. En consecuencia, un correcto diagnóstico diferencial es esencial. Nosotros exponemos el caso clínico de una mujer de 30 años con signos de hipocalcemia asociado a tetania como debut de la enfermedad celiaca. El presente caso destaca la importancia de un diagnóstico preciso de la enfermedad celiaca al considerar las causas de hipocalcemia, aunque no sea muy común, especialmente cuando se asocia a tetania

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

BACKGROUND: Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance. METHODS AND FINDINGS: A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified. Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05-4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81-4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63-2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future. CONCLUSIONS: Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice

Clinical research from a first level hospital. 5 years experience (2013-2017)

One of the products derived from the activity of health services is clinical research. In some studies, quality of healthcare in hospitals is related to clinical research. The first level hospitals have not been taken into account in these matters. They usually lack research management units support and have particular difficulties in this field. The present article describes clinical research of a first level hospital in Castilla-la Mancha from the publications in the last five years in which health personnel of this center participated. There is a reflection on the importance of promoting clinical research in these hospitals as well as maintaining a more significant relationship both with the university and with the larger hospitals and primary care centers in the area they serve

Autonomismo e humanização da assistência à saúde: uma parceria de fato?

Autonomismo y humanización de la asistencia sanitaria ¿una pareja de hecho?Autonomismo e humanização da assistência à saúde: uma parceria de fato?In recent times, a significant concern about the problem of the humanization of health care has been developed. This humanization affects the relationships of the health personnel with the patient as well as other issues such as the physical structures of the care centers and the organization of health system. This humanization of medicine has been linked to the so-called bioethical principlism, and specially to the principle of autonomy as a dominant bioethical principle. In this brief article, the author expresses the concern for the development of an exaltation of this principle (what has been called autonomism) linked to this movement of humanization of care.Para citar este artículo / To reference this article / Para citar este artigo Solís García del Pozo J. Autonomismo y humanización de la asistencia sanitaria ¿una pareja de hecho? pers. bioét. 2018; 22(2): 263-270. DOI: 10.5294/pebi.2018.22.2.5Autonomism and Humanization of Health Care. Domestic partnership?Autonomismo e humanização da assistência à saúde: uma parceria de fato?En los últimos tiempos se ha desarrollado una gran sensibilización por la humanización de la asistencia sanitaria. Esta humanización afecta las relaciones del personal sanitario con el paciente, así como las estructuras físicas de los centros sanitarios y la organización de la atención. Algunos autores han vinculado esta humanización de la medicina con la llamada bioética de los principios, y, en concreto, con la autonomía como principio bioético dominante. En este breve artículo se expresa la preocupación por el desarrollo de una probable exaltación de este principio (lo que se ha llamado autonomismo) vinculado a este movimiento de humanización de la asistencia.Para citar este artículo / To reference this article / Para citar este artigoSolís García del Pozo J. Autonomismo y humanización de la asistencia sanitaria ¿una pareja de hecho? pers. bioét. 2018; 22(2): 263-270. DOI: 10.5294/pebi.2018.22.2.5Autonomismo y humanización de la asistencia sanitaria ¿una pareja de hecho?Autonomism and Humanization of Health Care. Domestic partnership?Nos últimos tempos, uma grande sensibilização pela humanização da assistência à saúde tem sido desenvolvida. Essa humanização afeta as relações do pessoal da saúde com o paciente, bem como as estruturas físicas dos centros de saúde e a organização do atendimento. Alguns autores vincularam essa humanização da medicina à chamada “bioética dos princípios” e, em particular, à autonomia como princípio bioético dominante. Neste breve artigo, expressa-se a preocupação pelo desenvolvimento de uma provável exaltação desse princípio (o que tem sido chamado de “autonomismo”) vinculado a esse movimento de humanização da assistência.Para citar este artículo / To reference this article / Para citar este artigoSolís García del Pozo J. Autonomismo y humanización de la asistencia sanitaria ¿una pareja de hecho? pers. bioét. 2018; 22(2): 263-270. DOI: 10.5294/pebi.2018.22.2.

The Hospital de Santiago in Cuenca: an institution with 800 years history

The Hospital de Santiago in the city of Cuenca is one of the Spanish healthcare institutions that has maintained its activity for a longer time. Initially, this hospital was an institution for the redemption of captives in a border area of the kingdom of Castile with Al-Andalus, later it functioned as a hospital for the sick poor, maintaining its assistance activity despite the different destructions that the building has gone throughout its history. Currently, the hospital is a geriatric residence. Historical studies on hospitals have extended their scope of action, leaving the particular scope of institutional functioning and entering into areas as the hospital's relationship with the political, religious, social and economic environment. From this point of view, the hospital in Cuenca is still a little-explored ground to study these relationships in a city in interior Spain during a large part of the historical stages it has gone through, and especially from the Modern Age