[Adequancy of the pharmacological disponibility in a Department of Internal Medicine to the WHO essential drug list]. / Adecuación de la disponibilidad farmacológica en un Servicio de Medicina Interna a la lista de medicamentos esenciales de la OMS.

INTRODUCTION: Since several years ago, the World Health Organization (WHO), publishes the Essential Drug List (EDL) including medicines that are used to cover the mayor health community problems. Drugs are selected in terms of importance, usefulness, safety and cost-effectiveness. There is no enough data about adequacy between this list and the current medical practise in Internal Medicine. MATERIAL AND METHODS: Both EDL (13 edition, reviewed on April 2003) and the list of medicines used in the Internal Medicine Department from the Hospital da Barbanza, Riveira, A Coruña (Spain), Fundación Pública del Servizo Galego de Saúde in 2004-2005 were compared. RESULTS: From the 27 groups included in the EDL, 2 groups were excluded because no regular use in Internal Medicine. Among the other 25 groups there were significant differences in 24 groups. Just in one group both lists were identical. In all the 24 groups with differences, we used an smaller amount of drugs that recommended in the EDL. We analysed 15 groups (the groups with at least 5 differences between both lists). Causes identified were as follows: drugs used in diseases that we used to send to another hospital (Reference Hospital) in groups 6,8 and 12; drugs not commonly prescribed in Internal Medicine in groups 1,4,13,14,18,19 and 21, and finally drugs not currently financed by the National Health System (group 27). CONCLUSIONS: After examining the adequacy of the list of drugs prescribed in Internal Medicine in a Community Hospital we conclude that its use is significantly lower than the standard recommendations derived from de WHO. Identified causes are treatments not covered in a Community Hospital needing to transfer patients to another hospital and the inclusion of drugs not commonly used in Internal Medicine. The WHO estimates that over 2000 million people can not currently access to essential drugs nor vaccines all over the world. The problem is not just a health problem but also a social, economic and ethic one. So, an accurate use of such essential drugs in developed Health Systems could be a good example of efficiency.

[Vitamin D treatment in childhood: an evidence based discussion]. / Tratamiento con vitamina D en la infancia: discusión de la evidencia.

Vitamin D treatment during childhood has been recommended in those younger than one. Evidence is not available to recommend this treatment in general population. Solar exposure is enough in most infants younger than 1 year, and this should be taken into account. Data showing optimal doses at this stage is not available to date. Our review suggests, solar exposure in Spain appears sufficient.

[Erectile dysfunction: an insufficiently valued problem in Internal Medicine. Study of patients and related medication]. / Disfunción eréctil: un problema poco valorado en Medicina Interna. Estudio de pacientes y medicación relacionada.

INTRODUCTION: Erectile dysfunction (ED) is a common disease and may be due to psychological or organic causes. It might point to a silent disease and its value could not only be in life quality but also directly resolving the health problem laying beneath. The evaluation of ED begins with sexual records and physical examination which have been reported to have a 95 percent sensitivity, and a 50 percent specificity. Additional diagnostic tests are needed to maximize specificity. Sexual impairment in general Internal Medicine patients has not been sufficiently studied yet. PATIENTS AND METHODS: Unselected ambulatory and hospital admitted patients were interviewed during 2003 using the International Index of Erectile Function (IIEF) ad the Sexual Health Interview for Men (SHIM). The cut-off point was 21. RESULTS: A total of 51 male patients were interviewed, middle age was 65 years old (30-88). Of these, 27 denied sexual activity (group I). Middle age in this group was 64 years old. In the 24 patients with sexual activity (group II) middle age was 61 years old. The IIEF score was less than 45 in 11 patients (groups I and II of erectile dysfunction) The SHIM middle score was 26 points. The score was < 21 in 10 patients (41.6%). Concordance between both test was 90.9%. Risk factors included: tobacco (12 patients), alcohol (9), hypertension (8), and diabetes (7) among others. CONCLUSION: Our investigation seems to show that a great number of patients attended by Internists have sexual impairment (41.6%). None of these were under specific therapy nor consulted for this disease. Middle age is lower among patients with sexual activity as compared with the group without sexual activity. This assessment should be included in the medical interview with the aim of prescribing specific therapy to improve patient's quality of life.

[Medicine in the adolescent]. / Medicina del adolescente.

UNLABELLED: The biologic, cognitive and sociocultural changes that occur during adolescence include a wide range such as to be best treated by internists, but focus in old ages is increasing and younger are being treated by others specialists. We review the data of those adolescents attended in our Hospital and discuss Internal Medicine interest in adolescents. MATERIAL AND METHODS: Epidemiological data, and clinical status of those patients between 15 and 21 years old admitted in our hospital during the period 1996-2002 were analysed. RESULTS: 5894 admissions of adolescent s patients were made in this period. 1326 (23%) where attended in the Internal Medicine Department. 755 (57%) were male. Main causes of admission were infectious diseases, (mostly urinary tract and respiratory infections). Tobacco and alcohol abuse were present in 160 (6%) patients. DISCUSSION: Adolescence marks the transition from childhood to adulthood. Health problems and deaths among adolescents and young adults result from accidents (mostly from motor vehicle), but there are conditions usually matter of our speciality. A significant number of patients are been attended by Paediatrics Department and such a speciality as Adolescence Medicine is mostly integrated by paediatric specialists. We consider as this paper show, these ages ranges are clearly matter of our specialty and best treated by internists, but probably need a better consideration in our training. The opportunity to incorporate more adolescents into practice if realized, could prove challenging for internists.

[Spondylodiskitis caused by Candida albicans. Report of two new cases]. / Espondilodiscitis por Candida albicans. Aportación de dos nuevos casos.

Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year old man and a 35 year old woman. Both were IDUs with a previous history of HIV infection. The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases.

[Health impact of 2003 heat wave at Hospital de Riveira (A Coruña)]. / Impacto de la ola de calor de 2003 en el Hospital de Riveira (A Coruña).

OBJECTIVES: Last summer 2003 took place an atmospheric situation considered as a heat wave. Importance of environmental factors in chronic diseases is well known, but few works analyse those of heat excess as we do in this paper. METHODS: We studied the effects of high temperatures on admission and mortality in Riveira, A Coruña, Spain, during the period from July 15th to August 15th 2003. RESULTS: Mean maximum temperature in this period was 26.1 degrees C. One hundred and thirty seven patients were admitted, age ranges between 16 and 93 years old. Sixteen died. Fifty four admissions (38.7%) were identified as related with heat wave and of those patients, 8 died. No heat stroke cases were identified. Main risk factors in our heat related admitted population, were previous lung disease and overweight. CONCLUSION: Heat related pathology is difficult to evaluate although it is quite important. It seems to be necessary to take measures in order to identify population at risk and reduce the effects related to this environmental factor since high risk patients are quite common in our daily practice.

[Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases]. / Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos.

INTRODUCTION: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. AIMS: To know the clinical characteristics in the presentation of the lung cancer in our health care area. MATERIAL AND METHODS: All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. RESULTS: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. CONCLUSIONS: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis.

Pneumoretroperitoneum after a therapeutic video enteroscopy.

A 68-year-old woman with repeated episodes of bleeding due to small bowel angiodysplasia developed a pneumoretroperitoneum after a video enteroscopic examination with electrocoagulation of both duodenal and jejunal lesions using a bipolar device. Pneumoretroperitoneum was probably related to intestinal perforation during the therapeutic procedure. Pneumoretroperitoneum completely resolved with conservative measures and there were no additional complications.