Dolor torácico secundario al consumo de drogas atendido en urgencias hospitalarias en España / Chest pain secondary to drug use treated in hospital emergency departments in Spain

Objetivo Conocer las características de los pacientes con dolor torácico (DT) asociado al consumo reciente de drogas. Método Estudio de los casos del Registro REUrHE atendidos en urgencias de 11 hospitales españoles por DT tras el consumo de drogas de uso recreacional. Resultados El DT supuso el 8,97% de las asistencias (varones 82,9%, p<0,001). La cocaína estaba presente en el 70% de los casos, seguida del cannabis (35,7%) y las anfetaminas y derivados (21,4%). La clínica inicial más frecuente fue: palpitaciones (45,5%, p<0,001), ansiedad (42,5%, p<0,001), hipertensión (13,6%, p<0,001) y arritmias (5,9%, p<0,001). Recibieron más tratamiento los pacientes con DT (81,9% vs. 74,1%; p<0,001), aunque ingresaron menos (7,6%, p=0,0), sin diferencias en cuanto a maniobras de reanimación cardiopulmonar, sedación, intubación, o ingreso en cuidados intensivos (1,9%). Conclusiones En el DT tras una intoxicación aguda por drogas predomina el uso de la cocaína, aunque aumentan los casos por consumo de cannabis (AU)

Objective To determine the characteristics of patients with chest pain (CP) associated with recent drug use. Methods Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. Results CP accounted for 8.97% of attendances (males 82.9%, P<.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, P<.001), anxiety (42.5%, P<.001), hypertension (13.6%, P<.001) and arrhythmias (5.9%, P<.001). Patients with TD received more treatment (81.9% vs. 74.1%; P<.001), although they were admitted less (7.6%, P=.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). Conclusions In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing (AU)

Chest pain secondary to drug use treated in hospital emergency departments in Spain.

OBJECTIVE: To determine the characteristics of patients with chest pain (CP) associated with recent drug use. METHODS: Study of cases from the REUrHE registry attended in the emergency department of 11 Spanish hospitals for CP following recreational drug use. RESULTS: CP accounted for 8.97% of attendances (males 82.9%, p<0.001). Cocaine was present in 70% of cases, followed by cannabis (35.7%) and amphetamines and derivatives (21.4%). The most frequent initial symptoms were: palpitations (45.5%, p<0.001), anxiety (42.5%, p<0.001), hypertension (13.6%, p<0.001) and arrhythmias (5.9%, p<0.001). Patients with TD received more treatment (81.9% vs 74.1%; p<0.001), although they were admitted less (7.6%, p=0.0), with no differences in terms of CPR manoeuvres, sedation, intubation, or admission to intensive care (1.9%). CONCLUSIONS: In CP following acute drug intoxication, cocaine use predominates, although cases of cannabis use are increasing.

Alargamiento del intervalo QTc en pacientes cons íntomas relacionados con el consumo de cocaína / QTc prolongation in patients with symptoms of cocaine use

Objetivo: Determinar si el consumo de cocaína produce alargamiento del intervalo QTc y sise correlaciona con los niveles de benzoilecgonina. Método: Estudio de los pacientes que consultaron en urgencias por síntomas relacionados con el consumo de cocaína durante el año 2009. Se recogió edad, sexo y consumo de fármacos potencialmente alargadores del intervalo QT. Se consideró alargado un QTc superiora 450 msg. Se realizaron niveles cuantitativos de benzoilecgonina. Se utilizó un grupo control de no consumidores de cocaína y se determinaron las diferencias entre los dos grupos. Resultados: Se recogieron 44 casos y 18 controles. El QTc estaba más alargado en los consumidores (445,7 vs 411,1 mseg; p < 0,001). El porcentaje de QTc patológicamente alargados fue superior en los consumidores (59,1% vs 16,7%; p = 0,002). No se encontró correlación entre los niveles de benzoilecgonina y la duración del QTc. Nueve pacientes estaban en tratamiento con fármacos con posibilidad de alterar el QT. No se encontraron diferencias entre el QTc de estos casos y el de los que no tomaban dichos fármacos, así como tampoco en el porcentaje de QTc patológicos. Conclusiones: El consumo de cocaína produce alargamiento del QTc, así como mayor porcentaje de QTc patológicamente largos. Estas diferencias no se ven influenciadas por la toma de fármacos alargadores del QT. No se ha encontrado correlación entre los niveles debenzoilecgonina y la duración del QT (AU)

Objetive: To assess the presence of QTc prolongation in emergency department patients with symptoms of cocaine intoxication and to determine whether QTc prolongation correlated with benzoylecgonine level. Methods: The records of all patients coming to the emergency department with symptoms of cocaine intoxication in2009 were reviewed to collect data on age, sex, and use of drugs that could cause QTc prolongation A QTc intervallonger than 450 milliseconds was considered prolonged. Benzoylecgonine levels were also recorded. A group of nonusers of cocaine were used as controls. Results: Data for 44 cases and 18 controls were included. The QTc interval was prolonged in cocaine users (445.7milliseconds vs 411.1 milliseconds in nonusers; P<.001). A higher percentage of cases had QTc prolongation (59.1% vs16.7% of the controls; P=.002). Benzoylecgonine level and QTc duration were not correlated. Nine patients were in treatment with drugs that could cause QT interval changes. However, QTc duration did not differ between these patients and others who were not taking those drugs; nor were the percentages of QTc interval disturbances different between these 2 patient groups. Conclusions: Cocaine use causes QTc prolongation and is associated with more observations of pathologically prolonged intervals. The differences are not influenced by medications that also prolong the QT interval. Benzoylecgonine level and QTc duration are not correlated (AU)

[Predictive factors of 2009 H1N1 virus infection in patients with influenza syndrome]. / Factores predictivos de infección por el virus de la gripe H1N1 2009 en pacientes con síndrome gripal.

INTRODUCTION: Polymerase chain reaction (PCR) testing is one of the better techniques for viral detection in nasopharyngeal swabs. The objective of this study was to assess the percentage of positive swabs and to determine whether there were differences according to PCR positivity. MATERIAL AND METHODS: A retrospective study of 362 patients with flu syndrome attended at the Emergency Department between July 15 and December 15, 2009, in whom PCR of nasopharyngeal swabs for the detection of H1N1 2009 influenza virus was performed. Those cases in which swab testing was adequately requested were identified, and patients were divided into two groups according to positive or negative results for H1N1 2009 influenza virus. RESULTS: Nasopharyngeal swab was inadequately ordered in 87. In the remaining 275 patients, PCR was positive in 141. Patients with positive nasopharyngeal swabs were younger (mean [SD] age 36.1 [15] vs 42.3 [18] years, P= 0.002), had lower white blood cell, neutrophil and lymphocyte counts, lower serum concentrations of C-reactive protein (5.15 [5] vs 10.5[12] mg/dL, P= 0.036) and lower incidence of radiological infiltrates (20.5% vs 33%, P= 0.036). In the logistic regression analysis, age, serum C-reactive protein levels, and lymphocyte count were independently associated with a positive nasopharyngeal swab. CONCLUSIONS: About 50% of patients with flu syndrome had positive nasopharyngeal swabs for H1N1 2009 influenza virus. Age, C-reactive protein, and lymphocyte count were independent predictors of positivity.

Tuberculosis en población inmigrante: casos diagnosticados en urgencias según el lugar de procedencia / Tuberculosis in an immigrant population: emergency department diagnoses, analyzed by place of origin

Objetivo: El Hospital del Mar de Barcelona cubre un área de influencia (AI) de 350.000habitantes. En 2006, el 15,7% de esta población eran inmigrantes. El objetivo de este estudio es describir la distribución por países y zonas geográficas de los pacientes diagnosticados de tuberculosis en urgencias. Adicionalmente, se muestra el país y zona geográfica de procedencia de los inmigrantes censados en nuestra AI. Método: Se incluyeron los inmigrantes diagnosticados de tuberculosis durante 2006 y2007. Los datos poblacionales se obtuvieron del padrón municipal. Para cada país y zona geográfica se evaluó el porcentaje que representaba respecto a la población inmigrante censada (PIC), y el porcentaje respecto al total de tuberculosis en inmigrantes diagnosticados en urgencias (PTU). Se calculó el índice PTU/PIC para evaluar los casos de tuberculosis ajustados según los datos poblacionales. Resultados: El número de inmigrantes censados en 2006 fue de 54.057. Las nacionalidades más frecuentes fueron la pakistaní (14,1%) y la ecuatoriana (10,1%) y las zonas geográficas fueron Latinoamérica (38,3%) y Europa Occidental (19,2%). Se diagnosticaron60 casos de tuberculosis en inmigrantes, y fueron más frecuentes los casos procedentes de Pakistán (26,7%), seguidos de Bolivia (15%), Europa del Este (11,7%) y África del Norte (8,3%). Las mayores puntuaciones PTU/PIC correspondieron a Bolivia, Pakistán, Europa del Este y Asia Central. Conclusiones: La mayoría de los nuevos casos de tuberculosis en inmigrantes visitados en urgencias corresponden a pacientes originarios de Pakistán y de Latinoamérica, pero el mayor índice PTU/PIC se observa en los procedentes de Bolivia y Europa del Este (AU)

Objectives: Hospital de Mar in Barcelona serves a population of 350 000 inhabitants. In 2006, 15.7% of this population consisted of immigrants to Spain. The aim of this study was to describe the distribution by country and geographic region of immigrant patients diagnosed with tuberculosis in the emergency department. Additionally, we show the countries and geographic regions of origin of all immigrants identified by the census as residing in the area the hospital serves. Methods: The study included immigrants diagnosed with tuberculosis in 2006 and 2007. Population data were obtained from municipal census records. By country and region of origin, we analyzed the number of immigrants with tuberculosis, calculating percentages of the overall immigrant population recorded in the census (PIPC) and of the total number of immigrants diagnosed with this disease in the emergency department (PTED). The ratio between the two percentages (PTED/PIPC) was calculated to create an index reflecting the number of tuberculosis cases adjusted for population data. Results: A total of 54 057 immigrants were identified in the 2006 census. The largest national groups were those from Pakistan (14.1%) and Ecuador (10.1%). The largest regional groups were those from Latin America (38.3%) and Western Europe (19.2%). Sixty cases of tuberculosis were diagnosed in immigrants. Most of these patients came from Pakistan(26.7%) and Bolivia (15%). Attending to geographic region, patients from Eastern Europe (11.7%) and those from North Africa (8.3%) were the most frequently diagnosed. The highest PTED/PIPC indexes corresponded to Bolivia, Pakistan, Eastern Europe, and Central Asia. Conclusions: Most new cases of tuberculosis in immigrants diagnosed in the emergency department were found in patients from Pakistan and Latin America, but the highest PTED/PIPC indices were those for Bolivia and Eastern Europe (AU)

Dolor torácico con elevación del segmento ST en un consumidor de cannabis / Chest pain with elevation of the ST segment in a cannabis consumer

La miocarditis se define como una inflamación del miocardio. Frecuentemente se asocia a afectación pericárdica constituyendo una miopericarditis. Su etiología es muy variada, e incluye agentes infecciosos, químicos como drogas de abuso, radiaciones e hipersensibilidad a fármacos. La causa más frecuente es la infección por enterovirus. Es más frecuente en niños, adolescentes y adultos jóvenes, con predominio del sexo masculino. Aunque las manifestaciones clínicas son muy variables, en algunos casos puede semejar un síndrome coronario agudo. Por otro lado, el consumo de cannabis, se ha asociado a vaso espasmo, infarto agudo de miocardio y taquiarrítmias. Se describe el caso de un varón joven, consumidor de cannabis, que consultó por dolor torácico con alteraciones electrocardiográficas y enzimáticas sugestivas de síndrome coronario agudo con elevación del ST. Se discute el diagnóstico diferencial, métodos diagnósticos y actitud terapéutica (AU)

Myocarditis is defined as inflammation of the myocardium, and it is frequently associated with pericardial involvement leading to myopericarditis. Myopericarditis may be due to different etiologies, including infectious and chemical agents, such as drugs of abuse, radiation and hypersensitivity to drugs. Infection caused by enterovirus is the most frequent cause. The disease is more common in children, adolescents and young adults with a predominance of the male sex. Although patients may present different clinical manifestations, in some cases symptoms may resemble an acute coronary syndrome. On the other hand, cannabis consumption has been associated with vasospasm, acute myocardial infarction and tachyarrhythmias. We describe the case of a young man who was a cannabis consumer and presented chest pain with biochemical and electrocardiographic abnormalities suggestive of acute coronary syndrome with an elevated ST segment. The differential diagnosis, diagnostic work-up studies and therapeutic approach are commented on (AU)

Efectos del tabaquismo sobre los niveles plasmáticos de osteoprotegerina en adultos jóvenes sanos / No disponible

El tabaco es un conocido factor de riesgo de osteoporosis, pero los mecanismos por los que se produce esta asociación siguen siendo objeto de debate. Estudiosprevios han evaluado las variaciones de osteoprotegerina plasmática, una citoquina que regula la osteoclastogénesis y la resorción ósea, en fumadores, conresultados dispares. En este estudio se analizaron los niveles de osteoprotegerina plasmática en un grupo de 49 voluntarios jóvenes sanos, pero no existierondiferencias entre fumadores y no fumadores. Tampoco se encontraron diferencias tras ajustar por las diferencias basales existentes en estrona en varones y enedad e ingesta de calcio en mujeres. En conclusión, fumar no parece influir en los niveles plasmáticos de osteoprotegerina en voluntarios jóvenes sanos

While tobacco smoke is a known risk factor for osteoporosis, the mechanisms that produce this association must still elucidated. Several previous studies have evaluated the variations in serum levels of osteoprotegerin, a cytokine that regulatesosteoclastogenesis and bone resorption in smokers, however, the results have been inconclusive. This study, which makes an analysis of serum levels ofosteoprotegerin in a group of 49 healthy young volunteers, did not find any influence of smoking on this parameter. There were also no differences followingadjustment for baseline differences in estrone in men and for age and calcium intake in women. In conclusion, tobacco smoking does not seem to influenceosteoprotegerin serum levels in healthy young volunteers

Parálisis facial periférica bilateral idiopática en una paciente de 38 años / No disponible

No disponible

Diabetes team consultation: impact on length of stay of diabetic patients admitted to a short-stay unit.

OBJECTIVE: To assess the impact of endocrinology team consultation on hospital stay and clinical outcomes of diabetic patients admitted with a primary non-diabetes-related diagnosis in a short stay unit (SSU). METHODS: Patients admitted to the SSU between 2001 and 2005. Between 2001 and 2003 there was no endocrinology team consultation available and the management of hyperglycemia was handled by the SSU team alone. From 2003 until 2005 an endocrinology team was in charge of diabetes care. We compared in both periods: prevalence of diabetes, length of hospital stay, mortality, early readmissions and number of patients requiring conventional hospitalization. RESULTS: In period 2001-2003, 1023 patients were admitted, among which 212 were diabetic (20.7%). Over the years 2003-2005, 892 patients were hospitalized, 223 were diabetic (25%). Clinical characteristics of diabetic patients from both periods were comparable, but glycaemia at admission was higher on the second period (217 mg/dl versus 198 mg/dl). The length of stay of diabetic patients in the second period decreased from 5.49 to 4.90 days. There were no significant differences in mortality (1.4% versus 0.4%) or in early re-admissions among the two periods. CONCLUSIONS: The intervention of a diabetes team diminished the average length of stay of diabetic patients.

Effect of smoking and smoking cessation on bone mass, bone remodeling, vitamin D, PTH and sex hormones.

OBJECTIVE: To assess the effect of smoking and smoking cessation on bone density, bone remodeling markers, sex hormones, and vitamin D-PTH axis in healthy young subjects. MATERIALS AND METHODS: We studied 74 healthy people (31 men, 43 women; mean age 32.2 (7) years) divided into 52 never smokers and 22 smokers, 15 of which stopped smoking for one month. RESULTS: Male smokers compared with never smokers showed lower BMD (0.971 (0.11) g/cm(2) vs. 1.069 (0.09) g/cm(2), P=0.042); higher plasma estrone levels (32.37 (10.13) pg/mL vs. 20.91 (5.46) pg/mL, P=0.001); and lower serum iPTH levels (16.2 (3.5) pg/mL vs. 28.8 (2.0) pg/mL, P=0.008). In women, BMD values were similar in smokers than in never smokers, but 25-hydroxyvitamin D levels were lower in smokers (31.9 (15.1) ng/mL vs. 16.8 (9.9) ng/mL, P=0.002). After adjusting by age and coffee consumption, female smokers had higher urinary-NTX levels than never smokers. After smoking cessation, statistically significant decreases of 25-hydroxyvitamin D and SHBG plasma levels were observed in men and women, respectively. CONCLUSIONS: Tobacco increases bone resorption and affects bone mass by some alterations in sex hormone metabolism, but also importantly by alterations on the vitamin D-PTH axis.

[Screening for bone disease risk with clinical factors in women after physiologic menopause]. / Cribado de riesgo óseo mediante factores clínicos en mujeres tras menopausia fisiológica.

BACKGROUND: Densitometric screening for osteoporosis in postmenopausal women has not been demonstrated cost-effective. We have tried to identify clinical factors for screening previous to densitometry avoiding unnecessary explorations. SETTING: outpatient clinics of a menopausal unit in a 450-bed general hospital. Cross-sectional study, in two steps, of two groups of 140 and 284 women attending for physiological menopause. A clinical questionnaire, physical data and lumbar densitometry (Hologic QDR 1000) were obtained classifying the cases as "normal" or "low bone mass" (osteopenia or osteoporosis) according with the WHO criteria. In the first group a logistic regression analysis was done to identify predictive factors for abnormal densitometry, then validated in the second group. Sensitivity, specificity, predictive values (PV) and classification ability of clinical factors were analyzed. RESULTS: Four factors were independent predictors of abnormal densitometry: age > 51 (odds ratio [OR] = 6.64; 95% CI, 2.36-18.7); body weight < 70 kg (OR = 4.32; 95% CI, 1.71-10.09); years of fertility < 32 (OR = 3.77; 95% CI, 1.36-10.04), and number of live births > 2 (OR = 3.47; 95% CI, 1.27-9.53). Presence of one factor offers: sensitivity 91.9%; specificity 15%; positive PV 66.6%, and negative PV 50%, whereas the presence of two factors offers: sensitivity 62.7%; specificity 70%; positive PV 79.9%, and negative PV 50.3%. Clinical screening allows, when two factors are present, to avoid a 35.5% of densitometries and the false-negative cases represent 18%. CONCLUSIONS: Detection of bone-risk clinical factors (abnormal densitometry) yields a screening, previous to densitometry, that avoids at least one third of explorations in women with physiological menopause, improving the efficiency of the test.

Vitamin D treatment in myelodysplastic syndromes.

Myelodysplastic syndromes (MDS) are a group of clonal disturbances with defective cellular differentiation. Vitamin D3 (VD) analogues can act on the differentiation and maturity of different cell lines. We studied the effects of VD on a series of patients with MDS in an open-design trial. Nineteen patients, 12 men and seven women, with MDS were included. Patients were 74.8 +/- 5.6 years (mean +/- SD), seven had refractory anaemia with ringed sideroblasts, five had refractory anaemia, one had refractory anaemia with excess of blasts and six had chronic myelomonocytic leukaemia. All the patients were in a low to intermediate risk group. Mean follow-up period was 26.21 months, range 9-75. Responders were defined as follows: granulocyte or platelet count increase by 50%, or haemoglobin increase of 1.5 g/dl or transfusion needs decrease by 50%. The first five patients received 266 microg of calcifediol three times a week and the other 14 received calcitriol (0.25-0.75 microg/d). Response was observed in 11 patients. In the calcifediol-treated group, one case responded, three were nonresponders, and one showed progression. In the calcitriol group, 10 were responders (two with major response), and four were non-responders. No correlation was observed between baseline levels of vitamin D metabolites and the presence of response. No hypercalcaemia was observed. Treatment with vitamin D3 metabolites could induce a long-standing response of the haematological disturbance in some low-intermediate risk MDS patients without inducing hypercalcaemia.