Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. / Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular.

BACKGROUND: To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features. PATIENTS AND METHODS: Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55years and women >65years who had a high or very high CVR. RESULTS: The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71±8.7years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95%CI: 1.02-1.1; P<.01), male sex (OR: 5.6; 95%CI: 1.6-18.8; P=.01), active smoking (OR: 3.22; 95%CI: 1.16-8.93; P=.024) and peripheral arterial disease (OR: 3.51; 95%CI: 1.73-7.09; P<.01). Diabetes mellitus was an independent protective factor (OR: 0.41; 95%CI: 0.22-0.78; P=.06). Those with subaneurysmal dilatation of the abdominal aorta (diameter 25-29.9mm) presented similar features as patients with AAA. CONCLUSIONS: The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease.

Tiempo de demora para la hospitalización tras la implantación del ingreso directo a cargo del Servicio de Urgencias / Changes in emergency admission times after the introduction of direct admission from emergency services

ObjetivoValorar el impacto en el tiempo de espera para el ingreso urgente dependiendo del facultativo responsable de éste, el médico de urgencias o el especialista del área médica.Material y métodoTras la autorización al servicio de urgencias hospitalarias para el ingreso directo de pacientes en las especialidades médicas, se definieron dos períodos de estudio: período A (previo al ingreso directo) y período B (tras su implantación). Se analizaron el número de pacientes atendidos, su gravedad, el número y porcentaje de ingresos y el tiempo medio de estancia.ResultadosEn ambos períodos se atendieron 41.917 pacientes (228,07 pacientes/día) y 41.948 (230,48 pacientes/día), respectivamente. El tiempo medio de estancia de los pacientes ingresados directamente desde urgencias disminuyó en 1h y 42m (p=0,001); por el contrario, los ingresos en planta de hospitalización del servicio de medicina interna mantuvieron un tiempo medio de espera similar en los dos períodos analizados.ConclusionesEl traspaso de la competencia del ingreso a los facultativos de urgencias disminuye el tiempo medio de estancia de los pacientes en dicha área, sin modificar el número de ingresos y reduciendo la carga asistencial de los facultativos de la planta de hospitalización(AU)

ObjectiveTo measure the differences of waiting time for the emergency admission depending on which professional is in charge ie. the emergency doctor or the specialist of a specific area.Patients and methodsOnce the Hospital Emergency Service was permitted to admit patients directly to the specialities, two periods of study where taken: Period A (before the direct admission) and Period B (after the implementation of it). The following was analysed: the number of patients taken, the complexity of their problem, the number of admissions and length of their stay.ResultsDuring Period A 41,917 patients were seen (228.07 patients/day) and during Period B 41,948 (230.48 patients/day). The average of the stay for those patients that were admitted directly from Emergencies had decreased by 1h and 42min (p=0.001). The admissions in the Internal Medicine Service kept the same waiting time in both periods.ConclusionsThe transfer of the responsibility of the admissions to emergency doctors has decreased the average waiting time of the patients in this area. The total number of admissions has not increased and has reduced the amount of work the different specialist(AU)

[Changes in emergency admission times after the introduction of direct admission from emergency services]. / Tiempo de demora para la hospitalización tras la implantación del ingreso directo a cargo del Servicio de Urgencias.

OBJECTIVE: To measure the differences of waiting time for the emergency admission depending on which professional is in charge ie. the emergency doctor or the specialist of a specific area. PATIENTS AND METHODS: Once the Hospital Emergency Service was permitted to admit patients directly to the specialities, two periods of study where taken: Period A (before the direct admission) and Period B (after the implementation of it). The following was analysed: the number of patients taken, the complexity of their problem, the number of admissions and length of their stay. RESULTS: During Period A 41,917 patients were seen (228.07 patients/day) and during Period B 41,948 (230.48 patients/day). The average of the stay for those patients that were admitted directly from Emergencies had decreased by 1h and 42 min (p=0.001). The admissions in the Internal Medicine Service kept the same waiting time in both periods. CONCLUSIONS: The transfer of the responsibility of the admissions to emergency doctors has decreased the average waiting time of the patients in this area. The total number of admissions has not increased and has reduced the amount of work the different specialist.

[Acute mushrooms poisoning]. / Intoxicaciones agudas por setas.

The collection and consumption of wild mushrooms by individuals with no mycological knowledge and their accidental ingestion by minors are responsible for a growing increase of poisonings. It is not usual for emergency care of a patient affected by mushroom poisoning to be based on recognition of the responsible species of fungus or access to a sample of the mushroom consumed. It is this reason knowledge of toxidromes is crucial. In the majority of cases, the symptoms are weak. Mortality is usually related to the development of potentially fatal liver necrosis after consumption of the fungus Amanita phalloides and others which contain amatoxins. Treatment is based on support measures but no specific treatments exist that are based on scientifically proven studies. In the following article the clues used in diagnosing which make it possible to carry out a syndromic diagnosis based on a period of latency will be analyzed. The mushrooms that are responsible for the most common syndromes, therapeutic options, as well as varieties of toxic fungus which may produce peculiar and exceptional symptoms are also reported.

Modificaciones en los ingresos y mortalidad de los pacientes con infección por VIH durante el período 2001-2003 (réplica) / Modifications in admissions and mortality of patients with HIV infection during the period 2001-2003 (response)

No disponible

[Admissions and mortality changes in a third-level care Hospital Internal Medicine Department (1996-2000). Influence of the modifications in the HIV infection treatment]. / Evolución de los ingresos y la mortalidad en un Servicio de Medicina Interna de un hospital de tercer nivel (1996-2000). Influencia de las modificaciones en el tratamiento de la infección por el VIH.

OBJECTIVE: To analyze the impact of highly active anti-retroviral therapy (HAART) on the admissions and mortality of patients with human immunodeficiency virus (HIV) infection and of all patients cared in an Internal Medicine Department. METHODS: A retrospective study with analysis of admissions and deaths in the Internal Medicine Department of a third-level care hospital between January 1996 and December 2000. HAART was introduced starting in 1997. Age, gender, main diagnosis at discharge, diagnosis related group (DRG) weight, death cause, and hospital stay were assessed globally and annually. RESULTS: During the study period 7,580 admissions took place, of which 939 were secondary to HIV infection related diseases. The incidence of HIV-related admissions declined in 32.9% and the case-fatality rate in 67.8% between 1996 and 2000, with increase at the same time of the number of patients with noninfectious respiratory pathology and of overall number of patients with infections. Average hospital stay of patients cared in the Internal Medicine Department remained stable, with reduction of 31.5% of that of the group with HIV infection starting in 1997. DRG complexity in this group decreased 0.56 points. CONCLUSIONS: The introduction of HAART has been associated to a reduction in the incidence of admissions, in the complexity of the diagnoses, and in the mortality in the group of patients with HIV infection. At the same time there was an increased in the number of patients with respiratory and infectious pathology different from that related to HIV.

Evolución de los ingresos y la mortalidad en un Servicio de Medicina Interna de un hospital de tercer nivel (1996-2000). Influencia de las modificaciones en el tratamiento de la infección por el VIH / Admissions and mortality changes in a third-level care Hospital Internal Medicine Department (1996-2000). Influence of the modifications in the HIV infection treatment

Objetivo. Analizar la repercusión de la terapia antirretroviral de gran actividad (TARGA) sobre los ingresos y mortalidad de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) en particular y sobre un Servicio de Medicina Interna en general. Métodos. Estudio retrospectivo que analiza los ingresos y éxitus producidos en el Servicio de Medicina Interna de un hospital de especialidades entre enero de 1996 y diciembre de 2000. La TARGA se introdujo a partir de 1997. Se valoraron edad, género, diagnóstico principal al alta, peso del grupo relacionado con el diagnóstico (GDR), causa de la muerte y estancia hospitalaria de forma global y distribuidas anualmente. Resultados. Durante el período se produjeron 7.580 ingresos, de los cuales 939 estuvieron producidos por patologías relacionadas con la infección por el VIH. El número de ingresos por VIH disminuyó en un 32,9% y la tasa de letalidad en un 67,8% entre 1996 y 2000, aumentando el volumen de pacientes con patología respiratoria no infecciosa e infecciones en general. La estancia media de los pacientes ingresados en el servicio se mantuvo estable, disminuyendo la del grupo con infección por el VIH un 31,5% a partir de 1997. La complejidad de los GDR en este grupo disminuyó 0,56 puntos. Conclusiones. La introducción de la TARGA se ha relacionado con una disminución en el número de ingresos, complejidad de los diagnósticos y fallecimientos en el grupo de pacientes con infección por el VIH. Ese lugar ha sido ocupado por enfermos con patología respiratoria e infecciosa diferente a la relacionada con el VIH

Objective. To analyze the impact of highly active anti-retroviral therapy (HAART) on the admissions and mortality of patients with human immunodeficiency virus (HIV) infection and of all patients cared in an Internal Medicine Department. Methods. A retrospective study with analysis of admissions and deaths in the Internal Medicine Department of a third-level care hospital between January 1996 and December 2000. HAART was introduced starting in 1997. Age, gender, main diagnosis at discharge, diagnosis related group (DRG) weight, death cause, and hospital stay were assessed globally and annually. Results. During the study period 7,580 admissions took place, of which 939 were secondary to HIV infection related diseases. The incidence of HIV-related admissions declined in 32.9% and the case-fatality rate in 67.8% between 1996 and 2000, with increase at the same time of the number of patients with noninfectious respiratory pathology and of overall number of patients with infections. Average hospital stay of patients cared in the Internal Medicine Department remained stable, with reduction of 31.5% of that of the group with HIV infection starting in 1997. DRG complexity in this group decreased 0.56 points. Conclusions. The introduction of HAART has been associated to a reduction in the incidence of admissions, in the complexity of the diagnoses, and in the mortality in the group of patients with HIV infection. At the same time there was an increased in the number of patients with respiratory and infectious pathology different from that related to HIV