RESUMO
Background: Epidemiological studies about acute poisoning are useful for developing clinical toxicology, especially those carried out in hospital emergency departments. We aimed to evaluate acute intoxication clinical and sociodemographic profile in South Aragon Hospital, Spain. Methods: We carried out a retrospective cross-sectional study. We included 442 patients treated for acute poisoning in the emergency department during the 3 years 2015-2018. In the inferential analysis, the Chi-square test was used to compare proportions, and the Mann-Whitney U-test was used to compare ranges. A confidence level of 95 per cent was considered in all tests. Results: The mean age was 44.1 years. 57.2% were men. Drugs of abuse were present in 243 patients (55%), drugs in 172 (38.9%), chemicals in 57 (12.9%) and three patients (0.7%) were poisoned by mushrooms. Nine different drugs of abuse, 73 drugs, 15 chemical compounds and 2 varieties of mushrooms were registered. Of the intoxicated patients, 92.3% had symptoms, 84.2% received treatment and 78.7% were discharged from the emergency department. Conclusions: We obtain a clear clinical and sociodemographic profile of intoxicated patients who come to the emergency department; the five toxins that cause most acute poisoning are: alcohol, benzodiazepines, antiarrhythmics, cannabis and carbon monoxide.
Assuntos
Benzodiazepinas , Serviço Hospitalar de Emergência , Masculino , Humanos , Adulto , Feminino , Estudos Retrospectivos , Estudos Transversais , Espanha/epidemiologiaRESUMO
Resumen ANTECEDENTES: El parto diferido o asincrónico ocurre cuando los fetos de un embarazo múltiple nacen con una diferencia de días o semanas. La finalidad es incrementar la edad gestacional del segundo gemelo y aumentar la tasa de supervivencia. CASO CLÍNICO: Paciente primigesta de 39 años, con embarazo gemelar bicorial, biamniótico logrado mediante fertilización in vitro. En la semana 23 + 2 acudió a urgencias por sangrado vaginal y dolor abdominal. En la especuloscopia se observó líquido amniótico claro y dilatación cervical de 4-5 cm. El registro cardiotocográfico reportó dinámica uterina franca. En la ecografía se visualizaron dos fetos: el primero en presentación podálica sin latido cardiaco y el segundo en transversa con latido cardiaco. Después del nacimiento del primer gemelo se observó la retracción del cuello uterino y desaparición de la dinámica uterina. El estudio ecográfico mostró la bolsa amniótica íntegra, sin signos de desprendimiento placentario ni pérdida del bienestar fetal. Se propuso a la pareja la posibilidad de realizar un cerclaje cervical y diferir el parto del segundo gemelo, hecho que fue aceptado. Se consiguió prolongar la gestación del segundo gemelo 77 días, que nació mediante parto, sin morbilidad materna ni fetal. CONCLUSIONES: El parto diferido es una práctica adecuada para incrementar la tasa de supervivencia del feto o fetos retenidos. Los protocolos asociados con este tipo de partos son variados. Se requieren estudios adicionales para establecer los criterios de tratamiento de este tipo de partos.
Abstract BACKGROUND: Delayed Interval delivery or asynchronous birth is when a multiple pregnancy`s fetuses are not born simultaneously, and with several day´s difference between their births. This practice´s objective is to increase the second twin´s gestational age and, as such, improve its survival rate. CLINICAL CASE: A 39 years-old patient with bicorial biamniotic twin pregnancy achieved by in vitro fertilization. At 23 + 2 weeks of pregnancy assisted to Emergency service for vaginal bleeding and abdominal pain. In the speculoscopy a clear amniotic fluid and cervical dilation of 4-5 cm was observed. The cardiotocographic record reported frank uterine dynamics. In the ultrasound, two files are displayed: the first in the syntax presentation in the heartbeat and the second in the transversal with heartbeat. After the birth of the first twin, retraction of the cervix and the disappearance of uterine dynamics were observed. The ecological study showed the amniotic bag intact, without signs of placental detachment or loss of fetal well-being. It was proposed to the couple the possibility of performing the cervical fence and the other part of the second day, which was accepted. It was possible to prolong the gestation of the second year to 77 days, which was born through childbirth, without registering maternal or fetal morbidity. CONCLUSIONS: Delayed Interval delivery is a good practice to increase the survival rate of a retained fetus or retained fetuses. The protocols associated with this type of births are varied. Additional studies are required to establish treatment criteria for this type of births.
RESUMO
UNLABELLED: The maintenance of cold chain can result difficult in Emergency Mobil Units that's why the aim of this study is to value the effectiveness of portable fridges with/without compressor and its cost-effectiveness by a computer simulation. METHODOLOGY: This descriptive, transversal and cost effectiveness analysis was developed in two Emergency Mobil Units of 061 Aragón of Alcañiz (Teruel) along a year. RESULTS: The results showed that in the fridge with compressor, the 93'8% of the temperatures was between 2 and 8 degrees C, where as in the fridge without compressor was of the 35,7%.The global and specific cost effectiveness ratio of the fridge with and without compressor were of 0,063 and 7,411 and of 0,080 and 147,55 respectively. DISCUSSION AND CONCLUSION: Fridge with compressor was more cost-effective, amortizing quickly its initial cost. This fridge had a better and more efficient thermoregulation what supposed a better conservation of drugs and lower costs, according to the model of simulation.