Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments.

OBJECTIVE: Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. METHODS: This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. RESULTS: A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0).. CONCLUSIONS: CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

Informe especial: Transmisión vertical de Chagas: situación epidemiológica de Chagas en embarazo y Chagas congénito en la maternidad Sardá: Primer semestre de 2018 / Special report: Vertical transmission of Chagas: epidemiological situation of Chagas in pregnancy and congenital Chagas in Sardá Maternity: first semester of 2018

Hasta la Semana Epidemiológica 36 de 2018 se notificaron en la Ciudad de Buenos Aires 104 casos de Chagas congénito, de los cuales se confirmaron 6 (5,8%), se descartaron 6 y el 88% restante aún no cuenta con el cierre de caso. Las comunas del sur de la Ciudad acumulan el 56% de los casos. Durante el primer semestre de 2018 se diagnosticaron en la Maternidad Sardá 67 mujeres con Chagas en el embarazo, de un total de 2972 partos realizados en la institución en ese periodo, lo que representa una prevalencia de 22,54 por cada mil embarazadas En este informe se busca describir la situación de la transmisión vertical de la enfermedad de Chagas en el primer semestre de 2018, entre SE 1 y 26; describir la modalidad de notificación de los casos por la Unidad de Promoción y Protección de la Salud (P y P); y reforzar la importancia de la notificación de Enfermedades de Notificación Obligatoria debido a su relevancia en la Salud Pública. Se presentan los casos de Chagas en embarazo por grupo etario, y según provincia de residencia, y se detallan propuestas para la optimización de resultados.

[Comparison of different strategies for short-term death prediction in the infected older patient]. / Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado.

OBJECTIVE: The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). METHODS: We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event.The antimicrobial susceptibility data and extended-spectrum beta-lactamase (ESBL) production in isolates recovered from intra-abdominal (IAI) (n=1,429) and urinary tract (UTI) (n=937) infections during the 2016- 2017 SMART study in 10 Spanish hospitals were analysed. RESULTS: We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS ≥ 2 and 0.698 (IC 95% 0.635-0.761; p<0.001) for qSOFA ≥ 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). CONCLUSIONS: Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index.

Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department.

The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 [standard deviation (SD) 5.6] years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% [95% confidence interval (CI) 53.1-75.9] and a specificity of 49% (95% CI 46.0-52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2-39.8) and a specificity of 94% (95% CI 91.9-95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2-88.6) and a specificity of 45% (95% CI 41.6-47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (p < 0.001) and specificity (p < 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66-0.79; p < 0.001) for the GYM score, 0.69 (95% CI 0.61-0.76; p < 0.001) for the qSOFA score and 0.65 (95% CI 0.59-0.72; p < 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.

[Characteristics and epidemiological changes for patients with urinary tract infection in the emergency department]. / Características y cambios epidemiológicos de los pacientes coninfección del tracto urinario en los servicios de urgencias hospitalarios.

BACKGROUND: The aim of this paper is to determine both the prevalence of urinary tract infection (UTI) in the emergency department (ED) and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. METHODS: Descriptive cross-sectional analysis at 49 Spanish ED during 12 months. All patients with infections and UTI diagnosis were included. All patients attended to in ED during the study were recorded as well. RESULTS: The study included 2,517 patients diagnosed with UTI, with a mean age of 55 (SD 23) years, 64.6%of whom were women. These patients represent 22%of infections in the ED and 3.2% of all patients in the ED. Thirty-six per cent were over 70 years old. Fifty one point nine per cent had some underlying disease (16.5%diabetes mellitus) and 32.7% had some risk factors for multi-resistant strains of bacteria. Eight point three percent met sepsis criteria. Seventy-one point nine percent of patients were directly discharged from the ED. CONCLUSIONS: UTI are very common infections in ED, with important associated comorbidities, high mean ages and a predominance in women. With respect to a decade before UTI has increased its prevalence (3.2%vs 2.1%) and the patients have a greater age [55.5 (SD 23) vs 52 (SD 22) years], more comorbidities (51.9% vs 40.6%) and clinical severity (8.3% vs 6.5%).

Características y cambios epidemiológicos de los pacientes con infección del tracto urinario en los servicios de urgencias hospitalarios / Characteristics and epidemiological changes for patients with urinary tract infection in the emergency department

Fundamento: El objetivo de este artículo es determinar la prevalencia y conocer los cambios epidemiológicos más relevantes en la última década en la infección del tracto urinario (ITU) en los servicios de urgencias (SU), así como el perfil y manejo de los pacientes. Métodos: Estudio descriptivo con análisis transversal, multicéntrico en 49 SU españoles durante 12 meses. Se incluyeron todos los pacientes con el diagnóstico de ITU y de infección. Se registraron todos los pacientes atendidos en los SU. Resultados: Se incluyeron 2.517 casos diagnosticados de ITU con una edad media de 55 ± 23 años, el 64,6% mujeres. Estos representan el 22% de las infecciones y el 3,2% de todos los pacientes del SU. El 36% de las ITU se registraron en pacientes con 70 o más años. El 51,9% tenían alguna enfermedad de base (16,5% diabetes mellitus) y el 32,7% alguno de los factores de riesgo de multirresistencia para bacterias. El 8,3% cumplían criterios de sepsis. El 71,9% de los pacientes recibieron el alta desde el SU. Conclusiones: Las ITU son infecciones muy frecuentes en los SU, con importante comorbilidad asociada, elevada edad media y predominio en mujeres. Respecto a una década anterior, las ITU han aumentado su prevalencia (3,2% frente a 2,1%) y el paciente tiene más edad [55,5 (DE 23) frente a 52 (DE 22) años], mayor comorbilidad (51,9% frente a 40,6%) y gravedad clínica (8,3% frente a 6,5%) (AU)

Background: The aim of this paper is to determine both the prevalence of urinary tract infection (UTI) in the emergency department (ED) and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. Methods: Descriptive cross-sectional analysis at 49 Spanish ED during 12 months. All patients with infections and UTI diagnosis were included. All patients attended to in ED during the study were recorded as well. Results: The study included 2,517 patients diagnosed with UTI, with a mean age of 55 (SD 23) years, 64.6% of whom were women. These patients represent 22% of infections in the ED and 3.2% of all patients in the ED. Thirty-six per cent were over 70 years old. Fifty one point nine per cent had some underlying disease (16.5% diabetes mellitus) and 32.7% had some risk factors for multi-resistant strains of bacteria. Eight point three per cent met sepsis criteria. Seventy-one point nine per cent of patients were directly discharged from the ED. Conclusions: UTI are very common infections in ED, with important associated comorbidities, high mean ages and a predominance in women. With respect to a decade before UTI has increased its prevalence (3.2% vs 2.1%) and the patients have a greater age [55.5 (SD 23) vs 52 (SD 22) years], more comorbidities (51.9% vs 40.6%) and clinical severity (8.3% vs 6.5%) (AU)

[Hospitalization of 780 episodes of infection in 10 Spanish emergency departments. Admission to conventional wards or short stay units?]. / Hospitalización de 780 episodios de infección en 10 servicios de urgencias españoles. ¿Ingreso convencional o unidad de corta estancia?

BACKGROUND: To study the clinical characteristics of patients with infection attending the emergency department (ED) and compare those admitted to a short stay unit (SSU) with those admitted to a conventional hospital ward (CHW). METHODS: A descriptive multicenter cross-sectional analysis of infected patients requiring admission from 10 ED with SSU. Data were collected for age, gender, comorbidities, risk factors for multiresistant pathogens, type of infection, sepsis criteria, microbiology and antibiotic treatment. RESULTS: We documented 780 admitted patients, mean age 70.43 years, 31% with heart disease, 29% COPD, 26% diabetes mellitus, 15% prior antibiotic therapy and solid neoplasm. Fifty-four percent were respiratory infections, 22% urinary infections and 8% intra-abdominal infections. Thirteen percent had septic syndrome and beta-lactam (64%) and fluoroquinolones (29%) were the most prescribed antibiotics. When comparing patients admitted to SSU (183) with those admitted to CHW (597), in the latter group there were more comorbidities (86% vs. 78%), more risk factors for multidrug-resistant pathogens (42% vs. 25%) and cultures from different sources were more frequently undertaken (80% vs. 64%) (p <0.05). CONCLUSIONS: According to our results, SSU may be an excellent alternative to CHW for patients with prevalent infection and less comorbidity and fewer risk factors for multidrug resistance.

Hospitalización de 780 episodios de infección en 10 servicios de urgencias españoles. ¿Ingreso convencional o unidad de corta estancia? / Hospitalization of 780 episodes of infection in 10 Spanish emergency departments. Admission to conventional wards or short stay units?

Fundamento: Determinar las características clínicas de los enfermos con infección que ingresan desde urgencias y comparar las que lo hacen en una unidad de corta estancia (UCE) con las unidades de hospitalización convencional (UHC). Material y métodos: Estudio descriptivo multicéntrico con análisis transversal en 10 servicios de urgencias con UCE de pacientes con infección que ingresan. Se analizó edad, género, comorbilidad, factores de riesgo para patógenos multirresistentes, tipo de infección, criterios de sepsis, microbiología y antibioticoterapia. Resultados: Ingresaron 780 enfermos; edad media 70,43 años; 31% con cardiopatía, 29% con EPOC, 26% con diabetes mellitus, 15% con antibioticoterapia previa y neoplasia sólida. El 54% eran infecciones respiratorias, 22% urinarias y 8% intraabdominales. El 13% presentó síndrome séptico y los antibióticos más prescritos fueron betalactámicos (64%) y fluorquinolonas (29%). Al comparar los episodios que ingresaron en UCE (183) respecto UHC (597), estos últimos tenían más comorbilidad (86% vs. 78%) y factores de riesgo de patógenos multirresistentes (42% vs. 25%) y se practicaban más cultivos (80% vs. 64%) (p<0,05). Conclusiones: Las UCE son una excelente alternativa a las UHC para enfermos con infección prevalente y con menor comorbilidad y factores de riesgo de multirresistencia (AU)

Background: To study the clinical characteristics of patients with infection attending the emergency department (ED) and compare those admitted to a short stay unit (SSU) with those admitted to a conventional hospital ward (CHW). Methods: A descriptive multicenter cross-sectional analysis of infected patients requiring admission from 10 ED with SSU. Data were collected for age, gender, comorbidities, risk factors for multiresistant pathogens, type of infection, sepsis criteria, microbiology and antibiotic treatment. Results: We documented 780 admitted patients, mean age 70.43 years, 31% with heart disease, 29% COPD, 26% diabetes mellitus, 15% prior antibiotic therapy and solid neoplasm. Fifty-four percent were respiratory infections, 22% urinary infections and 8% intra-abdominal infections. Thirteen percent had septic syndrome and beta-lactam (64%) and fluoroquinolones (29%) were the most prescribed antibiotics. When comparing patients admitted to SSU (183) with those admitted to CHW (597), in the latter group there were more comorbidities (86% vs. 78%), more risk factors for multidrug-resistant pathogens (42% vs. 25%) and cultures from different sources were more frequently undertaken (80% vs. 64%) (p<0,05). Conclusions: According to our results, SSU may be an excellent alternative to CHW for patients with prevalent infection and less comorbidity and fewer risk factors for multidrug resistance (AU)

Prevalencia de patología cardíaca en la enfermedad de Chagas: años 2004-2012. Programa y Red de Chagas de CABA / Prevalence of cardiac pathology in Chagas disease: 2004 -2012. Program and Chagas CABA network

El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo “Prevalencia de la Enfermedad de Chagas” de Érica G. Morais, que había obtenido el premio “Futuros Líderes”, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas

Respuesta de los autores a la carta: Variación de las características y epidemiología de los pacientes con neumonía adquirida en la comunidad atendidos en los servicios de urgencias hospitalarios / Authors' reply to the letter "Variation of the characteristics and epidemiology of patients with pneumonia acquired in the community treated in hospital A and E services"

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Características y cambios epidemiológicos de los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios / Characteristics and epidemiological changes for patients with community-acquired pneumonia in hospital emergency departments

Fundamento. El objetivo de este artículo es determinarla prevalencia y conocer los cambios epidemiológicos más relevantes en la última década en la neumonía adquirida en la comunidad (NAC) en los servicios de urgencias (SU), así como el perfil y manejo de los pacientes. Métodos. Estudio descriptivo con análisis transversal, multicéntrico en 49 SU españoles durante 12 meses. Se incluyeron todos los pacientes con el diagnóstico de NAC, de infección respiratoria y de infección. Se registraron todos los pacientes atendidos en los SU. Resultados. La prevalencia de la NAC ha aumentado entre los pacientes en el SU en la última década del 0,85%al 1,35% (p<0,001). El 51% de las NAC se registraron en pacientes con 70 o más años. El 69,8 % tenían alguna enfermedad de base y el 17,8% alguno de los factores de riesgo para desarrollar infección. El 11,7% cumplían criterios de sepsis, 4,6% de sepsis grave y el 3% shock séptico. El 37% de los pacientes recibieron el alta desde el SU. Conclusiones. El impacto y prevalencia de la NAC en los SU ha aumentado en la última década. Es la causa más frecuente de sepsis, sepsis grave y shock séptico, de ingreso en la unidad de cuidados intensivos y de fallecimiento por enfermedad infecciosa (AU)

Background. The aim of this paper is to determine both the prevalence of community-acquired pneumonia(CAP) in the A & E Department and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. Methods. Descriptive cross-sectional analysis at 49 Spanish A & E Departments during 12 months. All patients with infections, respiratory infection or CAP diagnosis were included. All patients attended to in A & E during the study were recorded as well. Results. CAP has increased its prevalence among patients in the A & E Departments in the past decade (0.85% to 1.35%, p <0.001). Fifty-one per cent were over70 years old. Sixty-nine point eight per cent had some underlying disease and 17.8% had risk factors. Eleven point seven per cent met sepsis criteria, 4.6% severe sepsis and 3% septic shock. Thirty-seven per cent of patients were directly discharged from the A & E Departments. Conclusions. The impact and prevalence of CAP in A &E Departments has increased in the last decade. It is the most common cause of sepsis, severe sepsis and septic shock, admission to intensive care units and death due to infectious disease (AU)

Acute Abdomen in a Patient With Homozygous Type I Hereditary Angioedema: Rapid Improvement in Computed Tomography Scans After C1 Inhibitor Replacement

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[Characteristics and epidemiological changes for patients with community-acquired pneumonia in hospital emergency departments]. / Características y cambios epidemiológicos de los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios.

BACKGROUND: The aim of this paper is to determine both the prevalence of community-acquired pneumonia (CAP) in the A & E Department and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. METHODS: Descriptive cross-sectional analysis at 49 Spanish A & E Departments during 12 months. All patients with infections, respiratory infection or CAP diagnosis were included. All patients attended to in A & E during the study were recorded as well. RESULTS: CAP has increased its prevalence among patients in the A & E Departments in the past decade (0.85% to 1.35%, p <0.001). Fifty-one per cent were over 70 years old. Sixty-nine point eight per cent had some underlying disease and 17.8% had risk factors. Eleven point seven per cent met sepsis criteria, 4.6% severe sepsis and 3% septic shock. Thirty-seven per cent of patients were directly discharged from the A & E Departments. CONCLUSIONS: The impact and prevalence of CAP in A & E Departments has increased in the last decade. It is the most common cause of sepsis, severe sepsis and septic shock, admission to intensive care units and death due to infectious disease.

Single oligoarray-based detection of specific M918T mutation in RET oncogene in multiple endocrine neoplasia type 2B.

The most important mutation associated with Multiple Endocrine Neoplasia type 2B (MEN 2B) is the change of thymine to cytosine in codon 918 of exon 16 in the RET oncogene (ATG â†’ ACG). The aim of this work was to develop a single oligoarray by using tandem hybridization to detect the T918C/RET mutation for MEN 2B patients. Two genetically non-related families were studied; each family had a member affected by MEN2B. Both patients presented the T918C/RET mutation in a heterozygous fashion. None of the relatives was positive for this mutation; thus, these cases arose de novo. The proper mutation was confirmed by with different tools, PCR-Fok I endonuclease, direct sequencing, and also using our oligoarray. In this case, it is suitable to use a DNA target smaller than 150 bases with single- or double-stranded DNA and short probes of 7-mer. It was also possible to detect the mutation by employing different sources of DNA, fresh or paraffin-embedded tissues. Therefore, the present oligoarray can identify the most common M918T mutation of RET oncogene from a variety of DNA sources with good specificity and be a good alternative in the molecular diagnosis for MEN 2B cases.

Management in the emergency room of patients requiring hospital treatment of community-acquired pneumonia.

INTRODUCTION: To identify factors influencing decisions in initial management of community-acquired pneumonia (CAP) admitted to hospital through Emergency departments. METHODS: Records of CAP adult patients admitted to 24 Spanish hospitals in January-March 2003 were reviewed. Patients sent for ambulatory treatment were excluded. RESULTS: 341 patients (67.0 +/- 24.6 years; 65.3% males) were included; 39% were taking antibiotics at attendance. PSI was (% patients): I-II (19.7%), III (14.7%), and IV-V (65.6%). Comorbidities were: COPD (37.2%), heart disease (24.6%), hypertension (17%), diabetes mellitus (10.8%), and malignancies (10%). Pneumococcal/Legionella urinary antigens were performed in 34.0%/42.2% patients. Fewer (p < or = 0.006) rapid tests were performed in class IV-V (p = 0.001), with higher (p < or = 0.01) pneumococcal positive results in class V. Initial treatment was fluoroquinolone (37.5%), beta-lactam + macrolide (26.4%), beta-lactam (22.9%), macrolide (4.7%), and others (8.5%). Patients referred to Internal Medicine had higher heart disease (p = 0.06) and hypertension (p = 0.001) as comorbidity than those at Short-Stay Units or Pneumology. COPD patients were equally distributed between Internal Medicine and Pneumology, with differences vs. Short-Stay Units. CONCLUSIONS: Rapid diagnostic tests were underused, maybe due to broad empirical treatments covering drug-resistant pneumococci and L. pneumophila (regardless PSI and comorbidity). Presence of comorbidities or positive results in rapid diagnostic tests seems to influence the medical ward to which the patient is referred to, but not initial treatment.

Management in the emergency room of patients requiring hospital treatment of community-acquired pneumonia / Manejo en la sala de urgencias de pacientes con neumonía adquirida en la comunidad que requieren tratamiento hospitalario

Introduction. To identify factors influencing decisions ininitial management of community-acquired pneumonia(CAP) admitted to hospital through Emergency departments.Methods. Records of CAP adult patients admitted to 24Spanish hospitals in January-Mars 2003 were reviewed. Patientssent for ambulatory treatment were excluded.Results. 341 patients (67.0 ± 24.6 years; 65.3 % males)were included; 39 % were taking antibiotics at attendance.PSI was (% patients): I-II (19.7 %), III (14.7 %), and IV-V(65.6 %). Comorbidities were: COPD (37.2 %), heart disease(24.6 %), hypertension (17 %), diabetes mellitus (10.8 %),and malignancies (10 %). Pneumococcal/Legionella urinaryantigens were performed in 34.0 %/42.2 % patients. Fewer(p ≤ 0.006) rapid tests were performed in class IV-V(p = 0.001), with higher (p ≤ 0.01) pneumococcal positiveresults in class V. Initial treatment was fluoroquinolone(37.5 %), beta-lactam + macrolide (26.4 %), beta-lactam(22.9 %), macrolide (4.7 %), and others (8.5 %). Patients referredto Internal Medicine had higher heart disease(p = 0.06) and hypertension (p = 0.001) as comorbidity thanthose at Short-Stay Units or Pneumology. COPD patientswere equally distributed between Internal Medicine andPneumology, with differences vs. Short-Stay Units.Conclusions. Rapid diagnostic tests were underused,maybe due to broad empirical treatments covering drug-resistantpneumococci and L. pneumophila (regardless PSI andcomorbidity). Presence of comorbidities or positive resultsin rapid diagnostic tests seems to influence the medicalward to which the patient is referred to, but not initialtreatment (AU)

Introducción. Identificación de los factores que influyenen el manejo inicial de los pacientes con neumoníaadquirida en la comunidad (NAC) ingresados en el hospitala través de los Servicios de Urgencias.Material y métodos. Se revisaron los registros de pacientesadultos con NAC admitidos en 24 hospitales españolesen el período comprendido entre los meses deenero-marzo de 2003. Los pacientes remitidos para tratamientoambulatorio fueron excluidos.Resultados. Se incluyeron 341 pacientes (67,0 ± 24,6años; 65,3 % varones). El 39 % estaba tomando antibióticosen el momento de atención en Urgencias. El grado deFine de los pacientes fue (% pacientes): I-II (19,7 %),III (14,7 %), y IV-V (65,6 %). Las comorbilidades fueron:EPOC (37,2 %), enfermedad coronaria (24,6 %), hipertensión(17 %), diabetes mellitus (10,8 %) y neoplasia (10 %). Lostests de antígenos urinarios de neumococo y Legionellafueron realizados en 34,0 % y 42,2 % pacientes respectivamente.En las clases IV-V (p ≤ 0,006) se realizaron menostests rápidos, con mayor número de resultados positivospara neumococos (p ≤ 0,01) en la clase V. El tratamientoinicial fue fluoroquinolonas (37,5 %), betalactámico +macrólido(26,4 %), betalactámico (22,9 %), macrólido (4,7 %),y otros (8,5 %). Los pacientes ingresados en Medicina Internatenían una mayor incidencia de enfermedad cardiaca(p = 0,06) e hipertensión (p = 0,001) como comorbilidadque aquellos ingresados en Neumología o en Unidades deCorta Estancia. Los pacientes con EPOC fueron igualmentedistribuidos entre Medicina Interna y Neumología, con diferenciasrespecto a las Unidades de Corta Estancia.Conclusiones. Los tests diagnósticos rápidos fueron infrautilizados,debido posiblemente a la amplia cobertura delos tratamientos empíricos cubriendo neumococo resistente yL. pneumophila (independientemente del Fine y la comorbilidad) (AU)

Tratamiento antimicrobiano de la agudización de la EPOC: Documento de Consenso 2007 / Antimicrobial treatment of COPD deterioration: Consensus Document 2007

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Contracepción de emergencia. Una perspectiva desde la adolescencia / Emergency contraception: a perspective from the adolescence

Justificación: La anticoncepción de emergencia es una demanda creciente en los diferentes grupos de edad. Objetivo: Describir el grado de conocimiento, actitudes y prácticas de adolescentes sobre anticoncepción de emergencia. Diseño: Descriptivo transversal. Participantes y métodos: Mediante encuesta autocumplimentada y anónima con 30 ítems sobre conocimientos, actitudes y prácticas relativas a anticoncepción de emergencia a 446 alumnos de dos Institutos de Educación Secundaria de Torrijos. Resultados: Son mujeres el 53.4%. Edad media: 15.6 años (rango: 13 a 19). El 33.1% (Intervalo de confianza de 95% 28.7-37.6) han mantenido relaciones sexuales, apreciando diferencia por edades (p<0.001). La valoración de conocimientos sobre anticoncepción de emergencia fue de 3.9 sobre 10; mayor en mujeres (4.3 vs. 3.5; p<0.001) y en edades superiores (p<0.001). La principal fuente de información son los medios de comunicación (45.3%), pero la más deseada son los profesionales sanitarios (86.3%). El 61.1% prefiere obtenerla en centros especiales para jóvenes. El 66.1% está de acuerdo en que solo debe usarse cuando falla el anticonceptivo habitual. Un 8.4% (Intervalo de confianza de 95% 4.5-14.9) de los que han mantenido relaciones sexuales ha usado alguna vez anticoncepción de emergencia. Un 9.1% son repetidoras. El 54.5% la obtuvo en urgencias de Atención Primaria. El 45.5% tuvo dificultades para conseguirla. Conclusiones: el grado de conocimiento sobre anticoncepción de emergencia es bajo. Un alto porcentaje no considera el método como de “emergencia”. En el rango de edades analizado, el uso es escaso

Justification: Emergency contraceptive (EA), is an increasing demanded on the different ages collectives. Aim: Describe the knowledge grade, attitudes and teenagers practices on EA. Design: Transversal descriptive. Methodology: Though self filling enquire and anonymous with 30 items about knowledge, attitudes, and practices relatives to EA to 446 students from the two "I.E.S Torrijos". Results: Women the 53.4% Average age: 15.6 years old ( rate: 13 to 19). The 33.1% (IC 95%, 28.7-37.6) have had sexual relations, noticing differences on ages (p 0.001). The knowledge valuation about EA was 3.9 over 10; bigger on women (4.3vs3.5; p 0.001) and on older ages (p 0.001). The main information source are the media, but the most wanted (wished) are the sanitary professional (86.3%). The 61.1% prefer to obtain it on especial centres to young people. The 61.1 % agree with must be use only when the usual contraceptive faies. A 8.4% (95%, 14.5-14.9) whom have had sexual relations has used at least once EA. A 9.1% are repeated. The 54.5% got it at the AP emergency. The 45.5% had troubles to get it. Conclusion: The knowledge grade about EA is not so high. A high percentage don’t consider the method as an "emergency" one. On the age’s rate analysed, the use is scarce