Triaje telefónico en Atención Primaria. Análisis de la implantación de un modelo / Telephone triage in Primary Care. Analysis of the implementation of a model

Objetivo: conocer la capacidad resolutiva del triaje de enfermería y la satisfacción de los usuarios. Material y métodos: entre las llamadas para consulta recibidas del 15 de febrero al 30 de junio de 2011 (n=663), la enfermera recogió variables demográficas, antecedentes de enfermedades crónicas, motivo principal de consulta, sintomatología del paciente y su actuación posterior. Entre tres y diez días después, se realizaba una encuesta de satisfacción sobre la atención recibida. Los datos se introdujeron en el programa Access Office® 2007 y fueron analizados mediante el programa SPSS® 19.0. Resultados: el triaje telefónico representa un 15,5% del total de consultas atendidas en el área de Pediatría. Se analizaron 663 llamadas, de las cuales el 52,8% correspondió a varones. Edad media: 4,9 años. Población inmigrante: 4,5%. Enfermedad crónica: 5,3%. Tiempo de evolución de la sintomatología: 2,9 días (desviación estándar: 2,8). Motivo de consulta clínico: 88,6% (fiebre 23,8%, tos 15,4% y odinofagia 9,1%), frente a los no clínicos: 11,4%. La enfermera derivó al pediatra el mismo día al 72,7%, de manera programada al 10% y lo resolvió sin intervención del pediatra en un 17,3% de las ocasiones. El 83% de las consultas no clínicas fueron resueltas sin precisar intervención del pediatra, frente a un 9% en el caso de las consultas clínicas. El 93,4% consideró útil el consejo recibido y un 93,9% no precisó ser atendido en ningún otro servicio. Conclusiones: la resolución de las consultas no clínicas sin intervención del pediatra fue muy alta frente a las consultas clínicas, en que fue mucho más baja. La satisfacción de los usuarios fue alta (AU)

Purpose: the aim of this study is to know the response capacity of the nurses’ telephone triage and users’ satisfaction. Materialand methods: among the calls received for consultations from February 15 to June 30 of 2011, the nurse collected demographic variables, history of chronic diseases, reason for consultation, symptoms of the patient and subsequent action. Three to 10 days later, a satisfaction survey on the care received was conducted. Data were entered in Access Office 2007 and analyzed using SPSS 19.0. Results: the telephone triage represents 15.5% of total consultations attended in the area of pediatrics. Calls analyzed: 663; 52.8% were male. The mean age was 4.9 years. Immigrant population: 4.5%. Chronic illness: 5.3%. The duration of symptoms was 2.9 days (SD: 2.8). Clinical consultations: 80.3% (23.8% fever; 15.4% cough; 9.1% sore throat). Nonclinical consultations: 19.7%. The nurse referred 72.7% of the cases to the pediatrician the same day, 10% were scheduled an appointment and 17.3% of cases were resolved without intervention of the pediatrician. Among nonclinical visits, 83% resolved without requiring clinical intervention of the pediatrician versus 9% in the case of clinical visits. Calls considering useful the nurse’s advice were 93.4% and 93.9% did not require to be treated in any other service. Conclusions: the resolution of non clinical visits without pediatrician’s intervention was very high compared to clinical visits. The user satisfaction was high (AU)

Rotavirus y crisis convulsivas. Una asociación poco frecuente aunque bien definida / Rotavirus and seizures. A well-defined uncommon association

Introducción: La infección por rotavirus, además de los síntomas digestivos, puede producir múltiples complicaciones neurológicas. Entre estas se encuentran las convulsiones afebriles asociadas a gastroenteritis leve (CBG). A pesar de tener unas características bien definidas, su incidencia es poco conocida. Métodos: Se seleccionaron los diagnósticos de diarrea aguda de los niños que fueron hospitalizados en el Hospital Donostia, entre julio-1996 y junio-2008 y con edades entre un mes y 5 años. Se seleccionaron aquellos casos con diagnóstico asociado de convulsión. Resultados: Se detectó rotavirus en 419 de los 1.114 niños hospitalizados por GEA (39,2%). Cinco (1,2%) presentaron un cuadro compatible con CBG. Los episodios sucedieron entre diciembre y enero en todos los casos. La edad media de presentación fue 19,6 meses. El número de crisis por paciente fue de 2,6 de media (rango 1–4). Todas las crisis fueron cortas, siendo la de mayor duración de 15min. La duración total del cuadro fue de 1,6 días de media, con un máximo de 3 días. Las pruebas complementarias realizadas en todos los casos, fueron normales. En el seguimiento posterior, uno de los niños a los 26 meses presentó de nuevo un cuadro compatible con esta entidad. Ninguno ha vuelto a presentar crisis y todos tienen un desarrollo psicomotor normal. Conclusiones: La entidad CBG, es una entidad poco frecuente dentro de las gastroenteritis agudas asociadas a rotavirus, pero tiene unas características clínicas muy precisas que permiten su identificación, pudiendo evitar excesivas pruebas complementarias y tratamientos médicos agresivos (AU)

Introduction: Rotavirus infection, besides gastrointestinal symptoms, may cause several neurological complications. Among these, are benign convulsions with mild gastroenteritis (CwG). Despite having well defined clinical features, its incidence is not well known. Methods: We selected discharge diagnoses of acute diarrhea in children aged 1 month to 5 years who were admitted to Donostia Hospital between July 1996 and June 2008. Among them, we selected those cases with concomitant diagnosis of seizure. Results: Rotavirus was detected in 419 of 1114 children hospitalized for gastroenteritis. (39.2%), Five (1.2%) had symptoms compatible with CwG. The episodes occurred between December and January in all cases. The mean age at diagnosis was 19.6 months. The number of seizures per patient was 2.6 (range 1–4). All the crises were short, the longest being 15min. The total duration of the episode was 1.6 days on average, with up to 3 days. Additional tests performed in all cases, were normal. In subsequent follow-up, one child at 26 months had another episode compatible with this entity at 26 months. During the follow-up period, all patients displayed normal psychomotor development with noe recurrence of seizures. Conclusion: CwG is a rare entity within all acute gastroenteritis associated with rotavirus, but has very specific clinical features that enable it to be identified which could avoid excessive medical tests, and aggressive treatment (AU)

[Rotavirus and seizures. A well-defined uncommon association]. / Rotavirus y crisis convulsivas. Una asociación poco frecuente aunque bien definida.

INTRODUCTION: Rotavirus infection, besides gastrointestinal symptoms, may cause several neurological complications. Among these, are benign convulsions with mild gastroenteritis (CwG). Despite having well defined clinical features, its incidence is not well known. METHODS: We selected discharge diagnoses of acute diarrhea in children aged 1 month to 5 years who were admitted to Donostia Hospital between July 1996 and June 2008. Among them, we selected those cases with concomitant diagnosis of seizure. RESULTS: Rotavirus was detected in 419 of 1114 children hospitalized for gastroenteritis. (39.2%), Five (1.2%) had symptoms compatible with CwG. The episodes occurred between December and January in all cases. The mean age at diagnosis was 19.6 months. The number of seizures per patient was 2.6 (range 1-4). All the crises were short, the longest being 15min. The total duration of the episode was 1.6 days on average, with up to 3 days. Additional tests performed in all cases, were normal. In subsequent follow-up, one child at 26 months had another episode compatible with this entity at 26 months. During the follow-up period, all patients displayed normal psychomotor development with noe recurrence of seizures. CONCLUSION: CwG is a rare entity within all acute gastroenteritis associated with rotavirus, but has very specific clinical features that enable it to be identified which could avoid excessive medical tests, and aggressive treatment.

Tolerabilidad y efectividad de almotriptán en atención primaria / Tolerance to Almotryptan and its effectiveness in primary care

No disponible

Identification of a novel nonsense mutation and a missense substitution in the vasopressin-neurophysin II gene in two Spanish kindreds with familial neurohypophyseal diabetes insipidus.

Familial neurohypophyseal diabetes insipidus (FNDI) is an autosomal dominant disease caused by deficiency in the antidiuretic hormone arginine vasopressin (AVP) encoded by the AVP-neurophysin II (AVP-NPII) gene on chromosome 20p13. In this study, we analyzed two families with FNDI using direct automated fluorescent, solid phase, single-stranded DNA sequencing of PCR-amplified AVP-NPII DNA. In one of the families, affected individuals presented a novel nonsense mutation in exon 3 of the gene, consisting in a G to T transition at nucleotide 2101, which produces a stop signal in codon 82 (Glu) of NPII. The premature termination eliminates part of the C-terminal domain of NPII, including a cysteine residue in position 85, which could be involved in the correct folding of the prohormone. In the second family, a G279A substitution at position -1 of the signal peptide was observed in all affected individuals. This missense mutation, which replaces Ala with Thr, is frequent among FNDI patients and is thought to reduce the efficiency of cleavage by signal peptidases.

[Q fever: epidemic outbreak of the pure febrile form]. / Fiebre Q: brote epidémico de la forma febril pura.

OBJECTIVE: To describe an epidemic of 30 cases of Q fever, none of which had respiratory manifestations. DESIGN: Descriptive study. SITE. General medicine practices in the Billabona Health Centre, which covers the populations of Billabona and Zizurkil. PATIENTS AND OTHER PARTICIPANTS: Thirty patients, 27 men and 3 women, were diagnosed by serology as having Q fever, during and epidemic of a type of fever in Spring 1990. INTERVENTIONS: They were treated with Doxiciclin, taken orally. MAIN MEASUREMENTS AND RESULTS: A general analysis and thoracic x-ray were carried out. The respiratory mechanism was not affected in any case. Transaminases were extremely high in 86% of cases. Other findings were: fever 100%, shivering 83.3%, sweating 96.6%, severe headache 86.7% and myalgia 73.4%. CONCLUSIONS: Faced with pseudoinfluenza symptoms, and in areas with high occurrence of Q fever, we should consider that we could be dealing with cases of Q fever, even when there are no respiratory manifestations.

[Ebstein's anomaly of the tricuspid valve. Study of 13 cases in childhood]. / Anomalía de Ebstein de la válvula tricúspide. Estudio de 13 casos en la infancia.

We describe 13 cases of Ebstein's anomaly of the tricuspid valve. Seventy percent of there cases were detected at one month of age. Ten patients died and 9 presented associated cardiac anomalies. Signs of right heart failure were the clinical date that made possible the diagnosis of the disease in the most severe cases in the neonatal period. Only two patients had alteration of the cardiac rhythm: One had tachycardia that ended with ventricular fibrillation and the other had a 2:1 heart block. Echocardiography was very useful to establish the diagnosis: one hundred percent of the patients showed a delay in closing of the tricuspid in relation to the mitral valve, with a range of 0,03 to 0,06 seconds. Angiocardiographic studies revealed a tricuspid valve displacement in 8 cases, and double contour image in 6. The septal and posterior leaflets were hypoplasic in the 10 anatomic cases and in 80 percent of them it was possible to differentiate the cords from the papillary muscles.

[Incidence of hypernatremic dehydration in acute infantile gastroenteritis]. / Incidencia de la deshidratación hipernatrémica en la gastroenteritis aguda infantil.

A retrospective study on the incidence in our hospital of hypernatremic dehydration was performed. Authors observed a linear decrease both in the frequency of hypernatremic dehydration and in the incidence of hypernatremias above 160 mmol/l, during the 8-year period included in the study. For the past few years a tendency to see affected babies of older age was also observed. We believe that the reasons for these facts are the new dietary habits in infancy feeding and specially the greater use of formulas with low solute and protein content.

[Gastroenteritis caused by Campylobacter jejuni in childhood]. / Gastroenteritis por "Campylobacter jejuni" en la infancia.

Fifteen patients with stool growth of "Campylobacter jejuni" are presented. In one case it was associated with growth of "Salmonella typhimurium". Fourteen cases presented as an acute gastroenteritis whereas the remainder case was considered to be an asymptomatic carrier. The incidence was 5.8%. The disease was more frequent in infancy (13 cases occurred in ages below one year). Diarrhea was the most frequent symptom (93.3%), with presence of macroscopic blood in the stool in 78.5% of these cases. In three cases the process was associated to cow's milk protein-sensitive enteropathy. Four patients were treated with erythromycin and the stool culture become negative at the end of therapy. In the untreated cases the stool culture become negative within a period from five to 15 days. In the asymptomatic carrier the stool culture become negative after a period of two months.

[Rhabdomyoma of the heart: three case report (author's transl)]. / Rabdomioma cardiaco. Aportación de tres nuevas observaciones.

Authors described three infants under three months of age with cardiac rhabdomyoma observed during a period of eight years. There was no clinical or pathological evidence of tuberous sclerosis. During this period of time they found two cases of tuberous sclerosis, without associated rhabdomyoma, among 2,457 necropsies. On the other hand none of 11 children with tuberous sclerosis under observation in this centre had any clinical evidence of rhabdomyoma. Presenting symptoms of the three cases were cyanosis, heart failure, heart murmurs and alterations of heart rhythm. Diagnosis was suspected on the bases of eco and angiocardiographic studies and was finally confirmed by necropsy. Surgical exeresis of the tumor was attempted in one of the cases, but was not possible because it was too large.