[Characteristics of acute pyelonephritis at a short-stay medical unit]. / Características de la pielonefritis aguda en una unidad de corta estancia.

OBJECTIVES: To analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. MATERIAL AND METHOD. A retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. RESULTS: 208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7+/-1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to cotrimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. CONCLUSIONS: Acute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications.

[Diabetic ketoacidosis in an emergency department]. / Cetoacidosis diabética en un departamento de Urgencias.

OBJECTIVE: We study clinical data and differences in the patients with Diabetic Ketoacidosis (CAD) attended in an Emergency Department (ED). METHODS: We described 15 patients with criteria for diagnosis of CAD during a 12-month period. We value prospectively clinical data, precipitating factors, diagnosis associated, previous diagnosed diabetes, complications, mortality and use of and intensive care unit (UCI). We comparing groups according two characteristics: age group and prior diagnosis of diabetes mellitus.

[Fixed-dosage combinations in the treatment of hypertension]. / Combinaciones en dosis fija para el tratamiento de la hipertensión.

The antihypertensive treatment with a single agent is not useful for the arterial pressure control in a significant number of patients. In such cases, combined treatment or drug substitution are recommended (sequential or substitutive monotherapy). In the last years, the fixed dose combinations in one single pharmaceutical preparation have proliferated. These associations must fulfill a number of conditions in order to be considered rational, as for instance the compatibility of its pharmacokinetic features, properly dosing, the absence of new secondary effects and the high efficiency showed in most of patients. The advantages of these combinations are the comfort and easiness of the therapeutic schema, antihypertensive action strengthening, less secondary effects when dose is reduced, and perhaps a synergism in the protection of target organs. The most popular combinations are: potassium sparing diuretic plus thiazide, diuretic plus beta block, diuretic plus ACEI, or calcium antagonist plus ACEI.

[Infectious pathology in diabetic patients cared for in an emergency department]. / Patología infecciosa en pacientes diabéticos atendidos en un departamento de urgencias.

OBJECTIVE: We study the influence of diabetes in the incidence of infectious diseases attended in an emergency department (ED). PATIENTS AND METHODS: 2,500 adult patients attended in the ED of a general hospital were examined. We value prospectively: clinical data, diagnosis in ED and rate of admissions, comparing two groups: Group A (175 diabetic patients), Group B (350 non diabetic control patients, with the same age and sex). We used the glycated Hb and the glucose levels to make a difference in A Group: patients with good control (A1 = Hb A1c < 8), patients with poor control (A2 = HbA1c > 8), patients with low glucose levels (A3 = glucose < 200 mg/dl) and high glucose levels (A4 = glucose > 200 mg/dl). RESULTS: Infectious disease are more frequent in diabetic patients than no diabetic (Group A = 13.1% vs Group B = 3.2%), certain amount pneumonia and urinary tract infection. Also the infectious diseases are more frequent in diabetic patients with high glucose levels (Group A4) than diabetic patients with low glucose levels (Group A3), but there were no significant differences between A1 and A2 groups. CONCLUSIONS: The presence of diabetes was bound up with a higher frequency of infectious diseases, above all pneumonia and urinary tract infection, in an ED. The importance of metabolic control in relation with infectious diseases is not definite in our study.

[Pericardial tamponade and carcinomatous lymphangitis as primary manifestation of lung neoplasm]. / Taponamiento pericárdico y linfangitis carcinomatosa como primera manifestación de neoplasia pulmonar.

Cardiac tamponade (CT) and Carcinomatous lymphangitis (CL) association as an initial clinical presentation of a neoplasm is very uncommon, creating diagnosis difficulties in the patient first evaluation. This paper reports one case of a male who was admitted in Emergency Department with clinical and radiological findings of heart failure. Following studies showed CT and CL secondary to a bronchial adenocarcinoma. Differential diagnosis is really important for its associated therapeutic implications because of the CT hemodynamic worsening situation due to the diuretic and vasodilators used in the treatment of heart failure. An echocardiography should be done because it is very useful for the initial evaluation of a heart failure of obscure origin.