[Emergency department activity during the 2003 summer heat wave]. / Impacto de la ola de calor del verano de 2003 en la actividad de un servicio de urgencias hospitalario.

BACKGROUND AND OBJECTIVE: Several thousands deaths were attributed to a heatwave during the summer of 2003 in Europe. The aim of this study was to analyze its consequences in an emergency department. PATIENTS AND METHOD: We performed a descriptive observational study of the patients admitted to our emergency unit between 15 July and 31 August, 2003. We also carried out a comparative study of these patients with those admitted during the same period of 2002. RESULTS: A total of 5197 patients were admitted in our unit during the summer of 2003, in comparison with 4672 in the same interval in 2002. An increase in rates of total fever (17% versus 12%; p < 0.001), non-infectious fever (29% versus 26%; p < 0.001), decompensation of a chronic cardiovascular or respiratory disease (14% versus 11%; p < 0.001), admission (28% versus 22%; p < 0.001), and mortality (2% versus 1%; p < 0.001) were registered during the summer of 2003, in comparison with the previous year. A multivariate study showed a higher risk of death in patients older than 70 years (p < 0.01), in fragile dependent people (p < 0.05), and upon the presence of abnormal blood levels of creatinine (p < 0.05) on arrival at the emergency department. We also found an association between daily maxim temperature and number of daily emergency visits (R2 = 0.15; p < 0.001), total percentage of patients with fever (R2 = 0.26; p < 0.001), percentage of patients with non-infectious fever (R2 = 0.07; p = 0.01), percentage of decreases (R2 = 0.04; p < 0.05), and percentage of hospital admissions (R2 = 0.15; p < 0.001). CONCLUSIONS: The summer 2003 heatwave resulted in an elevation of the total number of emergency visits and hospital admissions, and higher mortality and morbidity rates, especially in old people. In the future, preventive measures must be taken to limit the health consequences of any heatwaves to come.

Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case-control echocardiographic study.

AIM: Idiopathic paroxysmal atrial fibrillation (AF) occurs in patients with apparently normal heart. Its mechanisms may be complex and are poorly understood. The aim of the study was to evaluate whether patients with idiopathic AF have any structural abnormality that may explain the occurrence of AF. METHODS AND RESULTS: A case-control study was undertaken including 60 consecutive patients (mean age 48 +/- 12 years; 75% men) with idiopathic AF admitted to the emergency department. Sixty sex- and age-matched healthy volunteers made up the control group. An echocardiogram was performed in all patients and volunteers to assess the left atrial (LA) and ventricular (LV) dimensions and valvular function. LV diastolic function was also evaluated by analysis of the LV inflow and pulmonary vein flow velocity patterns and tissue Doppler imaging of the mitral annulus. All AF patients showed normal echocardiographic studies with similar LV dimensions, ejection fraction, and diastolic function when compared with normal controls. However, patients with AF had larger LA dimensions (27 +/- 3 vs. 24 +/- 3 mm/m(2)), LA area (10 +/- 2 vs. 8 +/- 2 mm(2)/m(2)), and LA volume (27 +/- 9 vs. 19 +/- 6 mL/m(2)) (P < 0.05 for all). Among patients with AF, there were no differences in LA size between patients with a first episode or recurrent paroxysmal episodes. CONCLUSION: Patients with idiopathic AF showed larger left atria when compared with controls, there being no differences between patients with a first episode or a recurrence. This suggests the presence of an enhanced substrate to develop idiopathic lone AF.

Evaluation of inflammatory and renal-injury markers in women treated with antibiotics for acute pyelonephritis caused by Escherichia coli.

The evolution and the relationship between inflammatory and renal-injury markers in women with acute uncomplicated pyelonephritis under antimicrobial therapy were investigated in a prospective study. Markers were measured before and 6 and 24 h after the intravenous administration of 1 g of ceftriaxone. Before treatment, the median levels of all markers except the serum creatinine levels were high. Twenty-four hours after the onset of antibiotic treatment, the C-reactive protein (CRP) level continued to be high, while the serum interleukin-6 (IL-6) levels and the urine IL-6, IL-8, albumin, and immunoglobulin G (IgG) levels decreased significantly. In contrast, serum creatinine and tumor necrosis factor alpha levels and urine N-acetyl-beta-glucosaminidase, alpha1-microglobulin, and beta2-microglobulin levels did not change over time. There was a significant correlation between IL-6 and IL-8 levels and urine albumin and IgG levels (urine albumin and IgG levels are glomerular and urinary tract-injury markers) as well as between serum CRP levels and the levels of the tubular-injury markers. In women with acute pyelonephritis, appropriate antibiotic treatment rapidly decreases serum IL-6 levels and urine IL-6 and IL-8 levels, which correlate well with urine albumin and IgG levels.

Impacto de la ola de calor del verano de 2003 en la actividad de un servicio de urgencias hospitalario / Emergency department activity during the 2003 summer heat wave

Fundamento y objetivo: Durante la ola de calor del verano de 2003 se registraron varios miles de fallecimientos en Europa. Se analizan las consecuencias de esta ola de calor en una sección de urgencias de medicina de un servicio de urgencias hospitalario. Pacientes y método: Estudio descriptivo de las características de los pacientes visitados en una sección de urgencias de medicina entre el 15 de julio y el 31 de agosto de 2003, y se compara con las de los que fueron atendidos durante el mismo intervalo en 2002. Resultados: El número total de pacientes atendidos en el verano de 2003 fue de 5.197, frente a los 4.672 del año anterior. Durante 2003 aumentó, con respecto al año 2002, el porcentaje total de pacientes con fiebre (el 17 frente al 12%; p < 0,001), fiebre de causa no infecciosa (el 29 frente al 26%; p < 0,001), descompensación de enfermedad crónica (el 14 frente al 11%; p < 0,001), ingresados (el 28 frente al 22%; p < 0,001) y fallecidos (el 2 frente al 1%; p < 0,001). Los factores predictivos independientes de mortalidad para los pacientes con fiebre visitados durante la ola de calor de 2003 fueron la edad superior a 70 años (p < 0,01), la dependencia para las actividades de la vida diaria (p < 0,05) y la alteración de las concentraciones de creatinina a su llegada a urgencias (p < 0,05). Además, encontramos una asociación lineal con significación estadística entre la temperatura máxima diaria y el número de visitas diarias a urgencias (R2 = 0,15; p < 0,001), así como con el porcentaje total de pacientes que se visitaron por fiebre (R2 = 0,26; p < 0,001), fiebre de causa no infecciosa (R2 = 0,07; p = 0,01), fallecidos (R2 = 0,04; p < 0,05) e ingresados (R2 = 0,15; p < 0,001). Conclusiones: Durante la ola de calor del verano de 2003 se produjo un aumento del número de visitas a urgencias y de ingresos hospitalarios, así como una mayor tasa de morbimortalidad, especialmente en las personas de edad avanzada. Las autoridades sanitarias deberían llevar a cabo medidas preventivas para limitar las consecuencias sobre la salud pública que pudieran derivarse de futuras olas de calor

Background and objective: Several thousands deaths were attributed to a heatwave during the summer of 2003 in Europe. The aim of this study was to analyze its consequences in an emergency department. Patients and method: We performed a descriptive observational study of the patients admitted to our emergency unit between 15 July and 31 August, 2003. We also carried out a comparative study of these patients with those admitted during the same period of 2002. Results: A total of 5197 patients were admitted in our unit during the summer of 2003, in comparison with 4672 in the same interval in 2002. An increase in rates of total fever (17% versus 12%; p < 0.001), non-infectious fever (29% versus 26%; p < 0.001), decompensation of a chronic cardiovascular or respiratory disease (14% versus 11%; p < 0.001), admission (28% versus 22%; p < 0.001), and mortality (2% versus 1%; p < 0.001) were registered during the summer of 2003, in comparison with the previous year. A multivariate study showed a higher risk of death in patients older than 70 years (p < 0.01), in fragile dependent people (p < 0.05), and upon the presence of abnormal blood levels of creatinine (p < 0.05) on arrival at the emergency department. We also found an association between daily maxim temperature and number of daily emergency visits (R2 = 0.15; p < 0.001), total percentage of patients with fever (R2 = 0.26; p < 0.001), percentage of patients with non-infectious fever (R2 = 0.07; p = 0.01), percentage of deceases (R2 = 0.04; p < 0.05), and percentage of hospital admissions (R2 = 0.15; p < 0.001). Conclusions: The summer 2003 heatwave resulted in an elevation of the total number of emergency visits and hospital admissions, and higher mortality and morbility rates, especially in old people. In the future, preventive measures must be taken to limit the health consequences of any heatwaves to come