Uso de sueros hipotónicos en la prescripción de la fluidoterapia intravenosa de mantenimiento / Use of hypotonic fluids in the prescription of maintenance intravenous fluid therapy

Introducción: Los fluidos isotónicos, en la mayoría de los casos, constituyen la forma más segura de administración de líquidos por vía intravenosa. Los objetivos de nuestro trabajo han sido describir las prácticas de prescripción de los fluidos intravenosos de mantenimiento y estudiar los posibles factores asociados. Material y método: Estudio transversal, descriptivo, multicéntrico de ámbito nacional, mediante encuesta on-line, difundida a través de sociedades científicas médicas y la Organización Médica Colegial, entre diciembre de 2016 y diciembre de 2017. Resultados: Un total de 487 encuestas fueron recibidas, 456 de pediatras. El 28,95% (IC 95%: 24,77-33,13) de ellos prescribían habitualmente fluidos hipotónicos y el 81,14% (IC 95%: 77,54-84,74) se basaba en la regla de Holliday y Segar para calcular el volumen total a infundir. El perfil del pediatra en España que utiliza fluidos hipotónicos intravenosos es el de médico residente de pediatría, pediatra que trabaja en áreas diferentes a las unidades de cuidados intensivos pediátricos, en hospitales privados, y aquellos que reconocen que no existe un consenso al respecto en su grupo de trabajo. Conclusiones: Más de una cuarta parte de los pediatras en nuestro país sigue utilizando los fluidos hipotónicos como fluidoterapia intravenosa de mantenimiento. Diferentes factores podrían estar asociados a este hecho. Estos estudios son prueba de las grandes dificultades existentes para trasladar el conocimiento a la práctica

Introduction: Isotonic fluids, in most cases, are the safest way to dispense fluids intravenously. The aim of this study was to determine the prescription of maintenance intravenous fluids and to study possible associated factors. Material and method: A descriptive, cross-sectional, multi-centre study was performed. A questionnaire was sent nationwide to several healthcare providers via an on-line survey, sent by email through different Medical Scientific Societies, and the Official Spanish Medical Association, between December 2016 and December 2017. Results: A total of 487 questionnaires were received, of which 456 were submitted by paediatricians. More than one quarter (28.95%) (95% CI; 24.77-33.13) of the paediatricians usually dispense hypotonic fluids and 81.14% (95% CI; 77.54-84.74) prescribe infusion rates based on the Holliday and Segar protocol. The general profile of paediatricians who prescribe hypotonic fluids intravenously in Spain are medical residents, paediatricians working in paediatric non-intensive care units, in private hospitals, and those who recognise that no consensus exists among their direct work colleagues regarding this subject. Conclusions: More than twenty-five per cent of all paediatricians in our country continue to use hypotonic fluids as maintenance intravenous fluid therapy. There might be several potential factors associated to this. These kind of studies provide evidence of the great difficulties in transferring scientific knowledge to clinical practice

[Use of hypotonic fluids in the prescription of maintenance intravenous fluid therapy]. / Uso de sueros hipotónicos en la prescripción de la fluidoterapia intravenosa de mantenimiento.

INTRODUCTION: Isotonic fluids, in most cases, are the safest way to dispense fluids intravenously. The aim of this study was to determine the prescription of maintenance intravenous fluids and to study possible associated factors. MATERIAL AND METHOD: A descriptive, cross-sectional, multi-centre study was performed. A questionnaire was sent nationwide to several healthcare providers via an on-line survey, sent by email through different Medical Scientific Societies, and the Official Spanish Medical Association, between December 2016 and December 2017. RESULTS: A total of 487 questionnaires were received, of which 456 were submitted by paediatricians. More than one quarter (28.95%) (95% CI; 24.77-33.13) of the paediatricians usually dispense hypotonic fluids and 81.14% (95% CI; 77.54-84.74) prescribe infusion rates based on the Holliday and Segar protocol. The general profile of paediatricians who prescribe hypotonic fluids intravenously in Spain are medical residents, paediatricians working in paediatric non-intensive care units, in private hospitals, and those who recognise that no consensus exists among their direct work colleagues regarding this subject. CONCLUSIONS: More than twenty-five per cent of all paediatricians in our country continue to use hypotonic fluids as maintenance intravenous fluid therapy. There might be several potential factors associated to this. These kind of studies provide evidence of the great difficulties in transferring scientific knowledge to clinical practice.

Pancreatitis crónica idiopática / Idiopathic chronic pancreatitis

No disponible

No disponible

Impacto de las Comunicaciones a Congresos Nacionales de Atención Primaria / Impact of Communications to National Primary Care Congresses

Objetivo. Analizar cuántas comunicaciones presentadas en los congresos nacionales de Atención Primaria (CNAP) se publican en revistas indexadas. Diseño. Estudio descriptivo retrospectivo. Emplazamiento y mediciones principales. Fuente de datos: libros de ponencias de los CNAP celebrados en el año 2001; a través del primer autor de la comunicación se buscó en internet [Medline e Índice Médico Español (IME)] si fue publicada, nombre de la revista, idioma, año y diseño del estudio. Resultados. Se presentaron 528 comunicaciones (46,6% orales). Encontramos indexadas en Medline 33 (6,3%) (31 en el congreso de SemFYC y 2 en el congreso de SEMERGEN; p = 0,0001) y en el IME 57 artículos indexados (10,8%). Las revistas que recogen un mayor número de comunicaciones publicadas son Atención Primaria y Semergen; en revistas de lengua inglesa se publicaron 3 artículos. Los estudios descriptivos fueron el diseño más frecuente. Conclusiones. En los CNAP se presentan muchas comunicaciones, aunque se publican pocas, fundamentalmente en las revistas de las Sociedades de Atención Primaria que organizan los congresos

Objective. To determine how many poster and free oral communications accepted by Spanish national primary care congresses are fi nally published in peer review journals as full text articles. Methods. This is a retrospective, descriptive study. We used the abstract books of the Spanish national primary care congresses held in 2001. We selected the free oral and poster communications and using the name of the fi rst author we searched on the Internet (PubMed and the Spanish Medical Index –IME-) for full text publications of these abstracts. We recorded the study design, journal name, language and year of publication of all articles found. Results. A total of 528 of these types of communications (46.6% oral) were accepted by Spanish national primary carecongresses in 2001. We found 33 articles indexed in PubMed (6.3%), 31 were from the SemFYC congress and 2 from the SEMERGEN congress; p=0.0001. On the IME, we found 57 articles (10.8%). The target journals were Atención Primaria and Semergen. We found three articles in English. Descriptive design was the most frequent design in the articles. Conclusions. Although we found numerous free oral and poster communications submitted and accepted by the Spanish national primary care congresses in 2001, it is clear that very fewof these studies become full text publications in peer review journals. These being mainly Spanish language journals

Palpitaciones como presentación de Taquicardia de QRS estrecho en Pediatría / Palpitation like debut of tachycardia of thin qrs in paediatrics

La taquicardia paroxística supraventricular (TPSV) es la disritmia sintomática más frecuente en lainfancia después de las extrasístoles. Se presenta en lactantes como insufi ciencia cardiaca, asociandocon frecuencia cardiopatías estructurales, y en niños mayores como palpitaciones, palidez y ansiedad.Presentamos el caso de un niño de 6 años, sin antecedentes de interés, que mientras estaba jugandopresentó un episodio de taquicardia regular de QRS estrecho a 250 latidos/minuto, compatible con eldiagnóstico de TPSV por reentrada auriculoventricular

The paroxysmal supraventricular tachycardia (PSVT) is the second symptomatic arrhythmia more frequentin infancy later extrasistols. It occurs in lactation like a hearth insuffi ciency, frequently associatedwith structural cardiopathy and in elder children like palpitations, paleness or anxiety. We show thecase of a 6 years old child without pathologic antecedents, who suffer an event of regular tachycardiadefi ned by thin QRS and a frequency of 250 bpm compatible with the diagnostic of PSVT by auriculoventricular reentry while he was playing (AU)

[Prevalence erectile dysfunction in patients with hypertension]. / Prevalencia de disfunción eréctil en pacientes con hipertensión arterial.

BACKGROUND: Erectile dysfunction (ED), defined as the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance, is closely associated with hypertension. We assessed the prevalence of ED in patients with hypertension at the primary care level. We analyzed factors associated with ED in these patients. We also worked out the relationship between cardiovascular disease risks and ED. PATIENTS AND METHOD: This transversal multicenter study was carried out in educational primary care centers. A total of 512 patients with hypertension completed the International Index of Erectile Function in its abridged form (IIEF-5). Their known cardiovascular risk factors, comorbidity, toxic habits and hypertension history were taken form their medical records. RESULTS: Of 512 patients, 5 were not included in the study because of incomplete data in the IIEF-5 questionnaire. Mean age was 63.36 years (range 30 to 86). The prevalence of erectile dysfunction was 46.5%. Correlation of ED with age [OR = 1.05 (1.028-1.075)], diabetes mellitus [OR = 2.06 (1.247-3.406)] and ischemic heart disease [OR = 3.15 (1.429-6.947)] did reach statistical significance (p < 0.05). A linkage with cardiovascular disease risks, as worked out by the Framingham study, was not found. CONCLUSIONS: We observe a high prevalence of ED in patients with hypertension.

Prevalencia de disfunción eréctil en pacientes con hipertensión arterial / Erectile dysfunction in patients with hypertension

FUNDAMENTO: La disfunción eréctil, entendida como la incapacidad persistente de lograr o mantener una erección suficiente para el desarrollo de una relación sexual satisfactoria, presenta una estrecha asociación con la hipertensión arterial. El objetivo es estimar la prevalencia de la disfunción eréctil en los enfermos hipertensos controlados en atención primaria, describir qué variables se asocian y determinar su relación con el riesgo cardiovascular (RCV). PACIENTES Y MÉTODO: Estudio transversal multicéntrico desarrollado en centros de salud docentes. En condiciones de práctica clínica real 512 hipertensos autocumplimentaron el Índice Internacional de la Función Eréctil abreviado (IIEF-5 o SHIM). De sus historias clínicas se extrajeron: factores de RCV conocidos, comorbilidad, hábitos tóxicos e historial de HTA. RESULTADOS: De los 512 pacientes, 5 fueron pérdidas por datos incompletos en el IIEF-5. La media de edad resultó de 63,36 años (extremos, 30-86). La prevalencia de la disfunción eréctil fue del 46,5 per cent. Se estimó relación estadísticamente significativa (p < 0,05) entre la disfunción eréctil y la edad (odds ratio [OR] = 1,05; IC del 95 per cent, 1,028-1,075), la diabetes mellitus (OR = 2,06; IC del 95 per cent, 1,247-3,406) y la cardiopatía isquémica (OR = 3,15; IC del 95 per cent, 1,429-6,947). No se encontró relación con el RCV calculado a partir del estudio de Framingham. CONCLUSIONES: En los enfermos con HTA se registra una alta prevalencia de disfunción eréctil (AU)