Demanda asistencial en un Servicio de Pediatría durante el estado de alarma secundario a la COVID-19 / Demand for care in a Pediatric Service during the state of alarm secondary to COVID-19

Antecedentes y objetivos. La COVID-19 es una enfermedad producida por el virus SARS-CoV-2. En España,entre el mes de marzo y junio de 2020 se declaró el primer Estado de Alarma con el fin de contener la pandemia.Nuestro objetivo es evaluar la demanda asistencial y lasenfermedades que acudieron a Urgencias Pediátricas y quefueron ingresadas durante el tiempo que duró el primer Estado de Alarma, comparando con los mismos meses delos años 2018 y 2019.Resultados. Existe una reducción del número de ingresosde 345 a 141, un incremento de la complejidad demostrada por una mayor duración de los ingresos hasta 7,3±12,4 días(6,2±8,6 días en 2018 y 4,8±6,9 en 2019). Las enfermedades infecciosas (principalmente las respiratorias) descendieron, permaneciendo estables los ingresos por neoplasias, patología psiquiátrica, apendicitis y enfermedades circulatorias. EnUrgencias Pediátricas, en los años 2018 y 2019 (de 1 marzoa 30 junio) se atendieron 9.075 y 8.525 pacientes, mientras que en el 2020 se atendieron 2.215, aumentando el porcentajede ingresos procedentes de urgencias del 3,6% y 3,4% al 6%en 2020. Las enfermedades que aumentaron de forma más importante fueron las lesiones traumáticas y las intoxicaciones. Tanto en los ingresos como en urgencias existe unincremento en la edad de los pacientes. Conclusiones. El Estado de Alarma influyó en la presión asistencial y en el tipo de enfermedades atendidas enel Servicio de Pediatría, con una disminución del número de Urgencias y de ingresos, un incremento de la edad y unamodificación del tipo de enfermedades atendidas.

Introduction and objectives. COVID-19 is a disease caused by the SARS-CoV-2 virus. In Spain, between March and June 2020, the first State of Alarm was declared in order to contain the pandemic. Our objective is to evaluate the health care demand and the diseases that came to the Pediatric Emergency Department and were admitted during the time that the first State of Alarm lasted, comparing with the same months of the years 2018 and 2019.Results. There is a reduction in the number of admissions from 345 to 141, an increase in complexity demonstrated by a longer duration of admissions to 7.3±12.4 days (6.2 ± 8.6 days in 2018 and 4, 8±6.9 in 2019). Infectious diseases (mainly respiratory) decreased, with admissions for neoplasms, psychiatric pathology, appendicitis and circulatory diseases remaining stable. In Pediatric Emergencies, in the years 2018 and 2019 (from March 1 to June 30), 9,075 and 8,525 patients were attended, while in 2020, 2,215 were attended, increasing the percentage of admissions from the emergency room of 3.6% and 3.4% to 6% in 2020. The diseases that increased most significantly were traumatic injuries and poisonings. Both in admissions and in emergencies there is an increase in the age of the patients. Conclusions. The State of Alarm influenced the care pressure and the type of diseases treated in the Pediatric Service, with a decrease in the number of Emergencies and admissions, an increase in age and a modification of the type of diseases treated (AU)

Colecistostomía percutánea como tratamiento de la colecistitis aguda en pacientes con alto riesgo quirúrgico / Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery

Objetivo. Evaluar los resultados de las colecistostomías percutáneas realizadas como tratamiento urgente de colecistitis aguda, en busca de predictores de supervivencia. Valorar la recurrencia de colecistitis tras la retirada del catéter en pacientes descartados para cirugía diferida, y buscar factores predictores de recurrencia. Material y métodos. Se revisan retrospectivamente 40 pacientes sometidos a colecistostomía durante dos años. Se analiza la relación de la supervivencia durante el periodo de hospitalización con la evolución de fiebre, dolor abdominal, leucocitosis y proteína C reactiva después del procedimiento. Se analiza la recurrencia de colecistitis tras la retirada del catéter en pacientes descartados para colecistectomía diferida por alto riesgo quirúrgico, así como la influencia de la colangiografía no permeable, la edad, el sexo y las comorbilidades en el porcentaje de recurrencias. Resultados. Durante la hospitalización fallecieron cuatro pacientes por shock séptico (10%). La colecistostomía mejoró significativamente la fiebre, la leucocitosis y el dolor abdominal en un máximo de 5 días tras el procedimiento, pero estas mejoras no tuvieron un efecto estadísticamente relevante sobre la supervivencia, por lo que no se consideran útiles como factores pronósticos. Entre los 15 pacientes descartados para cirugía hubo seis recurrencias de colecistitis (40%) con un seguimiento medio de 6,7 meses tras la retirada del catéter. Un paciente falleció por recurrencia. No se encontró asociación de recurrencia con los parámetros analizados. Conclusiones. La colecistostomía ofrece resultados similares a los obtenidos en otras series como tratamiento urgente de la colecistitis aguda en pacientes con alto riesgo quirúrgico. La retirada del catéter en pacientes descartados para cirugía con colecistitis litiásica es una opción desaconsejable debido al elevado riesgo de recurrencia de colecistitis en comparación con otras series (AU)

Objective. To evaluate the results of percutaneous cholecystostomy for urgent treatment of acute cholecystitis, with the aim of identifying factors that predict survival. To analyze the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, with the aim of identifying factors that predict recurrence. Material and methods. We reviewed 40 patients who underwent percutaneous cholecystostomy in a two-year period. We analyzed survival during hospitalization in relation with fever, abdominal pain, leukocytosis, and C-reactive protein before and after the procedure. We analyzed the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, as well as the influence of obstruction seen on cholangiography, age, sex, and comorbidities on the recurrence rate. Results. During the hospital stay, 4 (10%) patients died of septic shock. Cholecystostomy improved fever, leukocytosis, and abdominal pain within five days of the procedure, but these improvements did not have a statistically significant effect on survival and were not therefore considered useful prognostic factors. Among the 15 patients considered unsuitable candidates for delayed surgery, 6 (40%) had recurrences of cholecystitis during a mean follow-up period of 6.7 months after catheter withdrawal. We found no association between recurrence and any of the parameters analyzed. Conclusions. Outcomes in our series of patients with high risk for surgery who underwent cholecystostomy for urgent treatment of acute cholecystitis were similar to those reported in other series. Withdrawing the catheter in patients considered unsuitable candidates for delayed surgery is not recommended due to the high risk of recurrence of cholecystitis in comparison with other series (AU)

Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery.

OBJECTIVE: To evaluate the results of percutaneous cholecystostomy for urgent treatment of acute cholecystitis, with the aim of identifying factors that predict survival. To analyze the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, with the aim of identifying factors that predict recurrence. MATERIAL AND METHODS: We reviewed 40 patients who underwent percutaneous cholecystostomy in a two-year period. We analyzed survival during hospitalization in relation with fever, abdominal pain, leukocytosis, and C-reactive protein before and after the procedure. We analyzed the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, as well as the influence of obstruction seen on cholangiography, age, sex, and comorbidities on the recurrence rate. RESULTS: During the hospital stay, 4 (10%) patients died of septic shock. Cholecystostomy improved fever, leukocytosis, and abdominal pain within five days of the procedure, but these improvements did not have a statistically significant effect on survival and were not therefore considered useful prognostic factors. Among the 15 patients considered unsuitable candidates for delayed surgery, 6 (40%) had recurrences of cholecystitis during a mean follow-up period of 6.7 months after catheter withdrawal. We found no association between recurrence and any of the parameters analyzed. CONCLUSIONS: Outcomes in our series of patients with high risk for surgery who underwent cholecystostomy for urgent treatment of acute cholecystitis were similar to those reported in other series. Withdrawing the catheter in patients considered unsuitable candidates for delayed surgery is not recommended due to the high risk of recurrence of cholecystitis in comparison with other series.

Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años / Atrioventricular synchrony in patients with pacemaker with VDD mode pacing. A 14-year descriptive study

Objetivo: Analizar el rendimiento de la estimulación con marcapasos de modalidad VDD en pacientes con bloqueo auriculo-ventricular (AV) completo con especial atención a la permanencia en sincronía AV. Diseño: Se trata de un estudio retrospectivo observacional, descriptivo sobre una serie de casos. Ámbito: Servicio de Medicina Intensiva de un centro hospitalario de tercer nivel. Pacientes: Totalidad de pacientes con marcapasos VDD implantado entre 1994-2008. Variables: Se analizó causa de trastorno del ritmo, tiempo de mantenimiento de la sincronía AV, motivo de la pérdida de la misma, número de recambios de generador y motivo, edad a la que se hizo el primoimplante, incidencia de fallo de sensado auricular y de fibrilación auricular. Se comparó la población que entro en Fibrilación auricular con el resto que mantenían actividad auricular. Resultados: Se analizaron 95 pacientes, 49 (51,6%) varones y 46 (48,4%) mujeres con edad media de Edad 77,08±8,37 años. El síntoma más frecuente fue el presíncope y mareo con 43 casos (45,3%), el trastorno del ritmo más frecuente fue el bloqueo AV de IIIo con QRS ancho con 68 casos (71,6%). El tiempo medio de Sincronía AV mantenida fue de 73,01±4,2 meses, sin diferencias significativas entre diferentes causas de pérdida de la misma. Al final del estudio permanecían en sincronía AV estudio 56 casos (73,3%). Conclusiones: El tiempo de sincronía AV es elevado, siendo las causas más importantes de su pérdida, la entrada en fibrilación auricular y el infrasensado auricular (AU)

Objective: To analyze the performance of VDD mode pacing in patients with complete AV block with special attention on maintaining AV synchrony. Design: This is a descriptive, retrospective and observational study of a case series. Setting: Intensive Medicine Department of a tertiary Hospital. Patients: All patients with VDD pacemakers implanted between 1994 and 2008. Main measurements: The cause of the rhythm disorder, time of atrioventricular synchrony, cause of its loss, number of pacemaker replacement and reason, age when the first implant was performed, incidence of failure of atrial sensing and atrial fibrillation. We compared patients with atrial fibrillation with the rest who maintained normal atrial activity. Results: A total of 95 patients, 49 (51.6%) males and 46 (48.4%) female with mean age of 77.08±8.37 years, were analyzed. The most common symptom was dizziness and presyncope in 43 cases (45.3%), the most common rhythm disorder was the III AV block with wide QRS with 68 cases (71.6%). Average time of AV synchrony was maintained 73.01±4.2 months with no significant differences between different causes of synchrony loss. At the end of the study, 56 cases remained in AV synchrony (73.3%). Conclusions: The preservation time of AV synchrony is high, the most important causes of loss being entry in atrial fibrillation and atrial infrasensing (AU)

Evaluación de la eosinopenia como marcador de infección en pacientes ingresados en una Unidad de Cuidados Intensivos / Evaluation of eosinopenia as an infection marker in critical care patients

Objetivo: Evaluar la eosinopenia como marcador precoz de infección. Diseño: Estudio de cohortes retrospectivo. Pacientes: Enfermos de una UCI medicoquirúrgica con altos índices de gravedad. Variables de interés: Datos demográficos, diagnóstico, repercusión clínica, necesidad de ventilación mecánica, evolución, estancia y Acute Physiology and Chronic Health Evaluation II (APACHE II) en primeras 24h. Días 1-5: leucocitos y fórmula, plaquetas, SOFA y lactato. Pacientes divididos en 2 grupos: con y sin infección. Mejor punto de discriminación según curvas ROC. Resultados: Doscientos cuarenta y cuatro pacientes; 55 (22,5%) infectados. El 52,9% eran enfermos médicos, el 22,5% eran enfermos posquirúrgicos y el 24,6% eran enfermos politraumatizados. El APACHE II fue de 14,9±8,9. En regresión logística (variable dependiente de infección) las variables independientes son APACHE II, SOFA, monocitos y eosinófilos. La curva ROC para eosinófilos el primer día muestra área de 0,72; mejor punto de corte: 10 eosinófilos/ml, sensibilidad (S): el 64,8% y especifidad (E): el 70,9%. En pacientes médicos, el área bajo la curva ROC es de 0,80, con punto de corte ideal de 9 eosinófilos/ml; en pacientes quirúrgicos el área bajo la curva es de 0,53, con punto de corte de 54 eosinófilos/ml. Si combinamos eosinófilos y monocitos, el corte de 9 eosinófilos/ml en pacientes médicos con >400 monocitos/ml, tiene una S del 86,7%, una E del 74,7%, un valor predictivo positivo del 40,6% y un valor predictivo negativo del 96,6%; en pacientes posquirúrgicos con <400 monocitos/ml y punto de corte de 54 eosinófilos, una S del 100%, una E del 20%, un valor predictivo positivo del 52,9% y un valor predictivo negativo del 100%. Conclusiones: En una UCI medicoquirúrgica la eosinopenia no muestra buena capacidad discriminativa de presencia de infección, aunque combinada con la cifra de monocitos podría ser útil para descartarla (AU)

Introduction: To evaluate eosinopenia as an early marker of infection. Design: Retrospective cohort study. Patients: Medical-surgical ICU patients with high severity scores. Main variables: Data on days 1-5: Demographic data, diagnosis, clinical repercussion, mechanical ventilation, clinical development, length of stay, APACHE II, leukocytes, SOFA and lactate. Patients divided into two groups: with and without infection. ROCs (receiver operator characteristic) curves were plotted and best point for discriminative values determined. Results: 244 patients were included: 22.5% with infection. 52.9% medical, 22.5% surgical and 24.6% polytrauma patients. APACHE II: 14.9±8.9. In a logistic regression model of infection (dependent variable infection), the independent variables were: APACHE II, SOFA, monocytes and eosinophils. The ROC curve for eosinophils on the first day: area of 0.72; the best cut off value is 10 eosinophils/ml, with sensitivity (S): 64.8% and specificity (Sp): 70.9%. In medical patients, the area under curve is 0.80, with ideal cut off value of 9 eosinophils/ml; in surgical patients is 0.53, with a cut off ideal value of 54. We combined eosinophils and monocytes: a cut-off value of 9 eosinophils/ml in medical patients with >400 monocytes/ml, has: S: 86.7%, Sp: 74.7%, a positive predictive value (PPV) of 40.6% and a negative predictive value (NPV) 96.6%; in postsurgical patients with <400 monocytes/ml and a cut-off value of 54 eosinophils: S: 100%, Sp: 20%, PPV: 52.9% and NPV: 100%. Conclusions: In a medical-surgical ICU, the capacity to discriminate infection through examining eosinopenia is not high. It could be useful to rule out infection if we combined eosinopenia with monocytes count (AU)

[Atrioventricular synchrony in patients with pacemaker with VDD mode pacing. A 14-year descriptive study]. / Sincronía auriculo-ventricular en pacientes portadores de marcapasos con estimulación VDD. Estudio descriptivo de un periodo de 14 años.

OBJECTIVE: To analyze the performance of VDD mode pacing in patients with complete AV block with special attention on maintaining AV synchrony. DESIGN: This is a descriptive, retrospective and observational study of a case series. SETTING: Intensive Medicine Department of a tertiary hospital. PATIENTS: All patients with VDD pacemakers implanted between 1994 and 2008. MAIN MEASUREMENTS: The cause of the rhythm disorder, time of atrioventricular synchrony, cause of its loss, number of pacemaker replacement and reason, age when the first implant was performed, incidence of failure of atrial sensing and atrial fibrillation. We compared patients with atrial fibrillation with the rest who maintained normal atrial activity. RESULTS: A total of 95 patients, 49 (51.6%) males and 46 (48.4%) female with mean age of 77.08+/-8.37 years, were analyzed. The most common symptom was dizziness and presyncope in 43 cases (45.3%), the most common rhythm disorder was the III AV block with wide QRS with 68 cases (71.6%). Average time of AV synchrony was maintained 73.01+/-4.2 months with no significant differences between different causes of synchrony loss. At the end of the study, 56 cases remained in AV synchrony (73.3%). CONCLUSIONS: The preservation time of AV synchrony is high, the most important causes of loss being entry in atrial fibrillation and atrial infrasensing.

[Evaluation of eosinopenia as an infection marker in critical care patients]. / Evaluación de la eosinopenia como marcador de infección en pacientes ingresados en una Unidad de Cuidados Intensivos.

INTRODUCTION: To evaluate eosinopenia as an early marker of infection. DESIGN: Retrospective cohort study. PATIENTS: Medical-surgical ICU patients with high severity scores. MAIN VARIABLES: Data on days 1-5: Demographic data, diagnosis, clinical repercussion, mechanical ventilation, clinical development, length of stay, APACHE II, leukocytes, SOFA and lactate. Patients divided into two groups: with and without infection. ROCs (receiver operator characteristic) curves were plotted and best point for discriminative values determined. RESULTS: 244 patients were included: 22.5% with infection. 52.9% medical, 22.5% surgical and 24.6% polytrauma patients. APACHE II: 14.9+/-8.9. In a logistic regression model of infection (dependent variable infection), the independent variables were: APACHE II, SOFA, monocytes and eosinophils. The ROC curve for eosinophils on the first day: area of 0.72; the best cut off value is 10 eosinophils/microl, with sensitivity (S): 64.8% and specificity (Sp): 70.9%. In medical patients, the area under curve is 0.80, with ideal cut off value of 9 eosinophils/microl; in surgical patients is 0.53, with a cut off ideal value of 54. We combined eosinophils and monocytes: a cut-off value of 9 eosinophils/microl in medical patients with >400 monocytes/microl, has: S: 86.7%, Sp: 74.7%, a positive predictive value (PPV) of 40.6% and a negative predictive value (NPV) 96.6%; in postsurgical patients with <400 monocytes/microl and a cut-off value of 54 eosinophils: S: 100%, Sp: 20%, PPV: 52.9% and NPV: 100%. CONCLUSIONS: In a medical-surgical ICU, the capacity to discriminate infection through examining eosinopenia is not high. It could be useful to rule out infection if we combined eosinopenia with monocytes count.

Evaluación de un protocolo de perfusión continua de insulina en enfermos críticos / Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients

Objetivo. Analizar la eficacia y la seguridad de un protocolo de infusión continua de insulina para el control de la glucemia entre 100-140 mg/dl, evaluando los resultados mediante un método que considera todas las horas de tratamiento. Diseño. Estudio prospectivo observacional durante un período de dos meses y seguimiento hasta finalizar el tratamiento con insulina en perfusión. Ámbito. Unidad de Cuidados Intensivos polivalente de 23 camas. Pacientes. Cincuenta pacientes consecutivos mayores de 18 años con dos glucemias > 140 mg/dl distanciadas 4-6 horas. Se excluyeron los pacientes con dieta oral. Intervención. La velocidad de perfusión y la frecuencia de monitorización de la glucemia se realizaron de acuerdo con las normas del protocolo por parte del personal de enfermería. Principales variables de interés. Días de perfusión de insulina y número y valor de las glucemias realizadas. Se estudiaron los episodios de hipoglucemia, la glucemia media, el porcentaje de glucemias y de horas que el paciente estaba en cada tramo de glucemia. Resultados. La duración media del tratamiento fue 15,6 días (DE 12). Se recogieron un total de 17.768 horas y 8.111 glucemias. El 55,5% de las glucemias estuvieron entre 100-140 mg/dl, lo que representa el 63,9% de las horas. La glucemia media fue 133 mg/dl. Sólo se produjeron dos episodios de hipoglucemia severa (< 45 mg/dl). Conclusión. El protocolo fue seguro y permitió mantener un control glucémico adecuado. El análisis de todas las horas de tratamiento podría aportar más datos que el simple estudio del porcentaje de glucemias en el rango de la normalidad y la glucemia media

Objective. To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. Design. Prospective observational study over a two-month period and follow up until the end of insulin perfusion. Context. Twenty three-bed polyvalent ICU. Patients. Fifty consecutive patients > 18 years of age with 2 episodes of glycemia > 140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded. Intervention. The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff’s protocol. Main variables of interest. Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient’s blood glucose was in each range. Results. The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (< 45 mg/dl) occurred. Conclusion. The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level

[Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients]. / Evaluación de un protocolo de perfusión continua de insulina en enfermos críticos.

OBJECTIVE: To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. DESIGN: Prospective observational study over a two-month period and follow up until the end of insulin perfusion. CONTEXT: Twenty three-bed polyvalent ICU. PATIENTS: Fifty consecutive patients >18 years of age with 2 episodes of glycemia >140 mg/dl separated by 4-6 hours. Patients on an oral diet were excluded. INTERVENTION: The perfusion rate and the frequency of glycemia monitoring were set according to the nursing staff's protocol. MAIN VARIABLES OF INTEREST: Days of insulin perfusion and number and value of the blood glucose measurements taken. Episodes of hypoglycemia, mean blood glucose level, the percentage of hyperglycemia episodes, and the number of hours that the patient's blood glucose was in each range. RESULTS: The mean duration of treatment was 15.6 days (SD 12). A total of 17,768 hours and 8,111 blood glucose measurements were collected. 55.5% of the blood glucose measurements were between 100-140 mg/dl, and this represents 63.9% of the hours. The mean blood glucose level was 133 mg/dl. Only 2 episodes of severe hypoglycemia (<45 mg/dl) occurred. CONCLUSION: The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level.

Variación de patrones espirométricos encontrados en un mismo grupo de usuarios del consultorio de la Zarza. Distrito Sierra-Andévalo (Huelva) 2004 / Variations of spirometric patterns foundin the same group of users of the Zarzaconsultation. Sierra-Andévalo (Huelva)District 2004

INTRODUCCIÓN. Dentro de la controversia de que si la espirometría es una prueba complementaria que debe o no realizarse en Atención Primaria, tuvimos la oportunidad de contrastar los patrones espirométricos en un mismo grupo de pacientes, a los que se les realizó una espirometría dentro del protocolo de salud laboral, con la espirometría realizada en el consultorio rural de la Zarza. El objetivo del estudio fue ver si existía variabilidad entre los patrones espirométricos obtenidos en el reconocimiento de salud laboral y los obtenidos en el consultorio de la Zarza. MÉTODO. Estudio cualitativo descriptivo. RESULTADOS. Se observaron notables variaciones entre los patrones espirométricos del reconocimiento de salud laboral y los observados en el consultorio al mismo grupo de pacientes. CONCLUSIONES. La espirometría es una prueba que puede y debe realizarse en Atención Primaria. La preparación y la motivación son fundamentales a la hora de realizar la espirometría

INTRODUCTION. Within the controversy of whether the spirometry is a complementary tests that should be conducted or not in Primary Health Care, we had the opportunity to compare the spirometer patterns in this same group of patients in whom a spirometry was conducted within the occupational health protocol with that of a spirometry conducted in the rural Zarza clinic. This study aimed to discover if there was variability between the spirometric patterns obtained in the work occupational checkup and those obtained in the Zarza clinic. METHOD. Descriptive qualitative study. RESULTS. Important variations were observed between the spirometric patterns of the occupational health checkup and those observed in the clinic in the same group of patients. CONCLUSIONS. The spirometry is a test that can and should be conducted in Primary Health Care. Preparation and motivation are fundamental when performing the spirometry

Manifestaciones electrocardiográficas en la hipotermia / Electrocaridographic manifestations of hypotermia

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