Conductas de riesgo: entrevista al adolescente en el Servicio de Urgencias / Risk behaviours: interview of the adolescent in the Emergency Service

Objetivos. Determinar los hábitos tóxicos y sexuales de los adolescentes que acuden a Urgencias. Métodos. Estudio prospectivo realizado del 1/1/2010 al 31/12/2011, basado en encuestas a adolescentes y que incluye preguntas dirigidas a conocer su hábitos tóxicos y sexuales. Resultados. Se realizan 279 encuestas (2,8% de adolescentes atendidos). El 51,3% son mujeres. La edad media es 14,5 años (DE: 1,5). El 22,2% son inmigrantes. La distribución de los adolescentes según edad, sexo y origen no presenta diferencias significativas entre grupos. El 51,6% (IC95%: 45,8-57,4%) de los adolescentes refiere contacto con alguna sustancia psicoactiva; el 47% alcohol, 24% tabaco, y 12,5% cannabis. La proporción de consumidores de las 3 sustancias aumenta progresivamente con la edad (de 4,9%, 4,9% y 0% a los 12 años a 95,8%, 58,3% y 45,8%, respectivamente, a los 17 años: p<0,001). No se hallan diferencias significativas ene l consumo de las tres sustancias según el origen del paciente. El 20,4% (IC95%: 15,8-25,1%9 manifiesta tener relaciones sexuales, el 17,6% de ellos sin método anticonceptivo. Conclusiones. Los hábitos tóxico y sexuales hallados en los adolescentes atendidos en Urgencias son superponibles a los referidos en encuestas realizadas a este grupo de edad en otros ámbitos, pudiendo ser Urgencias un buen sitio para la promoción de hábitos saludables (AU)

Objectives. To describe the toxic and sexual behavior of adolescents who are seen in the Emergency Department (ED). Methods. Prospective study from 1/1/2009 to 31/12/2011, based on surveys of adolescents. The study includes questions to know their toxic habits and sexual behavior. Results. We perform 279 surveys (2.8% of adolescents seen), 51,3% are women. The mean age is 14.5 years (SD 1.5). 22,2% are immigrants. The distribution of adolescents according to age, gender and origin do not present significant differences between groups. The 51,6% (CI95%: 45.8-57.4%) of adolescents refer contact which any psychoactive substance, 47% alcohol, 24% tobacco and 12,5% cannabis. The proportion of consumers of the 3 substances increases progressively with age (since 4.9%, 4.9% and 0% at 12 years, to 95,8% , 58,3% and 45,8% at 17 years, p<0.001). No significant differences were found in the consumption of the three substances according to the origin of the patient. The 20.4% (CI95%: 15.8-25.1%) manifested having sexual intercourse, 17.6% without contraceptive method. Conclusions. The toxic habits and sexual behavior found in adolescents seen at the ED are similar to those reported in surveys of this age group in other fields. ED may be a good place to promote healthy habits (AU)

Evolución de los ingresos por maltrato infantil durante 15 años / Hospital admissions due to child maltreatment over a fifteen year period

Objetivo: Determinar la evolución de la incidencia de ingresos por maltrato entre 1995 y 2009 y describir sus principales características clínicas y epidemiológicas. Métodos: Estudio retrospectivo de los niños con diagnóstico de alta de maltrato durante 15 años en un hospital de tercer nivel. Resultados: Se incluyen 97casos (incidencia mediana: 0,5 maltratos por 1.000 niños ingresados y año). Aumentan los ingresos por maltrato físico y disminuyen los de abuso sexual. Cincuenta y uno (53,6%) eran se sexo femenino; edad mediana 3.3 años (p25-75: 7,6 meses-10,0 años). El motivo de consulta no estaba relacionado con maltrato en 42 (43,3%) casos. Los hematomas (43; 44,3%) fueron las lesiones más frecuentes. En 91 (93,8%) casos el agresor fue un familiar (77; 74,9%, uno o ambos padres). Conclusiones: El aumento de ingresos por maltrato físico hace necesario insistir en políticas de prevención. La disminución en los casos de abusos sexuales probablemente sea más por cambios en los circuitos de atención a las víctimas que por una disminución real. En casi la mitad de los casos la sospecha surgió tras el examen físico o ante resultados de pruebas complementarias, siendo aconsejable tener presente el maltrato en el diagnóstico diferencial de múltiples motivos de consulta. La mayoría de los maltratos se producen dentro del entorno familiar(AU)

Aim: To measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics. Methods: Retrospective review of children diagnosed with maltreatment over 15years in a third level hospital. Results: A total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both). Conclusions: The increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family(AU)

[Hospital admissions due to child maltreatment over a fifteen year period]. / Evolución de los ingresos por maltrato infantil durante 15 años.

AIM: To measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics. METHODS: Retrospective review of children diagnosed with maltreatment over 15 years in a third level hospital. RESULTS: A total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both). CONCLUSIONS: The increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family.

Perfil de los adolescentes que acuden a urgencias por intoxicación enólica aguda / Profile of adolescents seen in emergency departments with acute alcohol poisoning

Introducción: En los últimos años ha aumentado la prevalencia de la Intoxicación Enólica Aguda (IEA) en adolescentes. Una de sus repercusiones ha sido el incremento de las consultas en los Servicios de Urgencias (SU). El objetivo de este estudio es evaluar el perfil psicosocial de los adolescentes que consultan por IEA y estudiar su funcionamiento personal, familiar y social. Método: Se entrevistaron telefónicamente a 104 familias de casos de adolescentes atendidos en el SU por una IEA y se comparó con 104 controles emparejados por edad y sexo, para obtener datos sociodemográficos, clínicos, académicos y de funcionamiento familiar. Resultados: El 72% de los adolescentes que consultaron por una IEA tenía una edad inferior a 16 años. El 37.7% repitió un curso escolar, el 20% presentó absentismo escolar y el 19.6% abandonó los estudios básicos. 9.8% estaba en tratamiento psiquiátrico. Sólo el 11,4% de los pacientes fueron derivados a un dispositivo especializado. No se encontraron diferencias estadísticamente significativas en ninguna de las variables clínicas entre el grupo de estudio y el control. Conclusiones: Este estudio aporta información sobre las características de esta población y orienta sobre la necesidad de desarrollar protocolos de actuación en los SU que contemplen no sólo los parámetros bioquímicos/toxicológicos sino que también incluya la valoración de parámetros psicosociales (AU)

Introduction: In recent years, the prevalence of Acute Alcohol Intoxication (AAI) in adolescents has increased. One of its impacts had been the increase in consultations in the Emergency Services (ES). The objective of this study is to assess the psychosocial profile of adolescents who consult for AAI and study their personal, family and social functioning. Methods: 104 families of adolescents who attended for AAI in ES and 104 controls, matched by age and sex, were interviewed by telephone to obtain sociodemographic, clinical, academic and family functioning data. Results: 72% of the adolescents who were attended for AAI were under 16 years old. Academic data showed that 37.7% had repeated a school year, 20% had truancy and 19.6% abandoned their basic studies. 9,8% were in psychiatric treatment. Only 11.4% of patients were referred to specialist service. There were no significant differences between in any of the clinical variables between the study and control group. Conclusions: This study provides new information on the characteristics of this population and provides guidance on the need to develop protocols for working in the ES that includes not only biochemical/ toxicological parameters but also includes the assessment of psychosocial parameters (AU)

[Profile of adolescents seen in emergency departments with acute alcohol poisoning]. / Perfil de los adolescentes que acuden a urgencias por intoxicación enólica aguda.

INTRODUCTION: In recent years, the prevalence of Acute Alcohol Intoxication (AAI) in adolescents has increased. One of its impacts had been the increase in consultations in the Emergency Services (ES). The objective of this study is to assess the psychosocial profile of adolescents who consult for AAI and study their personal, family and social functioning. METHODS: 104 families of adolescents who attended for AAI in ES and 104 controls, matched by age and sex, were interviewed by telephone to obtain sociodemographic, clinical, academic and family functioning data. RESULTS: 72% of the adolescents who were attended for AAI were under 16 years old. Academic data showed that 37.7% had repeated a school year, 20% had truancy and 19.6% abandoned their basic studies. 9,8% were in psychiatric treatment. Only 11.4% of patients were referred to specialist service. There were no significant differences between in any of the clinical variables between the study and control group. CONCLUSIONS: This study provides new information on the characteristics of this population and provides guidance on the need to develop protocols for working in the ES that includes not only biochemical/ toxicological parameters but also includes the assessment of psychosocial parameters.

¿Quién da positivo para cannabis en urgencias de pediatría? / Who gives a positive cannabis in paediatric emergencies?

Introducción y objetivo: El cannabis, es la droga ilegal más consumida en nuestro país, siendo la adolescencia el momento clave de toma de contacto con esta sustancia. El objetivo de este trabajo es valorar las características de los pacientes con consumo reciente de cannabis que acuden a un servicio de urgencias pediátricas con el fin de determinar su perfil y valorar su seguimiento. Material y métodos: Se revisaron los informes de los pacientes que dieron positivo para cannabis en el examen de tóxicos en orina durante los años 2007-2008. Se valoraron las características epidemiológicas (la edad, el sexo, la presencia de antecedentes psiquiátricos y tutela por la administración), el motivo de consulta, el especialista que solicitó la prueba y su resultado, el consumo asociado de otras drogas y el destino al alta. Resultados: Se determinó cannabis en orina en 533 pacientes, resultando positivo en 72 (13,5%) casos. Excluyendo un lactante con intoxicación accidental, su edad media fue 16,2 años (DE 1,2 años; rango 13,4-18 años); 43 (60,6%) eran varones. Trece (18,3%) adolescentes estaban tutelados por la administración y 24 (33,8%) tenían antecedentes psiquiátricos. Treinta y cinco (48,6%) consultas fueron entre viernes y domingo, sin predominio horario. Los motivos de consulta más frecuentes fueron alteración del nivel de conciencia 29 (40,3%) y agitación 19 (26,4%). En 12 (16,7%) casos se detectó el consumo asociado de alcohol y en 4 (5,6%) de cocaína. En 42 (58,3%) ocasiones los pacientes fueron dados de alta a domicilio, en 20 (27,8%) ingresaron y en 10 (13,9%) fueron seguidos ambulatoriamente. Conclusiones: Se observó un predominio de consumo de cannabis en varones adolescentes. Fue relativamente frecuente la existencia de problemática psicosocial asociada y de consumo de otras drogas de abuso. Fueron bastantes los pacientes que se fueron de alta desde urgencias de pediatría sin ningún tipo de supervisión posterior, siendo importante mejorar en este aspecto (AU)

Introduction and aim: Cannabis is the most frequently consumed illicit substance in Spain. Adolescence is the period when most people come into contact with this drug. The aim of this study is to evaluate the characteristics of patients who have recently consumed cannabis and who are evaluated in the Paediatric Emergency Department in order to pinpoint their profile and do a follow-up. Material and method: Study of the medical reports of patients who tested positive for cannabis in urine toxicological analysis over 2 years (2007-2008). Epidemiological characteristics (patient age, sex, psychiatric antecedents and if they were placed in institutional care) as well as the patient's reason for checking into hospital, the specialist who asked for the test, the test result, its positivity for other drugs of abuse and the patient's whereabouts once he or she had been released from hospital were evaluated. Results: Seventy-two of 533 patients tested positive for cannabis. Excluding one child with an accidental intoxication, their mean age was 16.2 years (SD 1.2 years; range 13.4¨C18 years-old); 43 (60.6%) were male. Thirteen (18.3%) teenagers were being looked after by the Administration and 24 (33.8%) had psychiatric antecedents. Thirty-five (48.6%) consultations took place from Friday to Sunday, with no particular increase in the number of patients in specific time-periods. The medical consultations were mainly related to alterations in the level of consciousness 29 (40.3%) and agitation 19 (26.4%). In 12 (16.7%) cases the patients had also been known to have drunk alcohol, and 4 (5.6%) of them had also taken cocaine. In 42 (58.3%) occasions, patients were discharged to home, 20 (27.8%) were admitted to the hospital and 10 (13.9%) were referred to the outpatients’ department for a follow-up. Conclusions: There was a predominance of teenage males in the consumption of cannabis. In many cases, there was a related psycho-social element to the use of the substance and those who consumed cannabis appeared in many cases to have consumed other drugs of abuse. There are still many patients who, after having checked into the Paediatric Emergency Department, show no record of having received a proper follow-up. We highlight the need to improve this aspect (AU)

[Who gives a positive cannabis in paediatric emergencies?]. / ¿Quién da positivo para cannabis en urgencias de pediatría?

INTRODUCTION AND AIM: Cannabis is the most frequently consumed illicit substance in Spain. Adolescence is the period when most people come into contact with this drug. The aim of this study is to evaluate the characteristics of patients who have recently consumed cannabis and who are evaluated in the Paediatric Emergency Department in order to pinpoint their profile and do a follow-up. MATERIAL AND METHOD: Study of the medical reports of patients who tested positive for cannabis in urine toxicological analysis over 2 years (2007-2008). Epidemiological characteristics (patient age, sex, psychiatric antecedents and if they were placed in institutional care) as well as the patient's reason for checking into hospital, the specialist who asked for the test, the test result, its positivity for other drugs of abuse and the patient's whereabouts once he or she had been released from hospital were evaluated. RESULTS: Seventy-two of 533 patients tested positive for cannabis. Excluding one child with an accidental intoxication, their mean age was 16.2 years (SD 1.2 years; range 13.4-18 years-old); 43 (60.6%) were male. Thirteen (18.3%) teenagers were being looked after by the Administration and 24 (33.8%) had psychiatric antecedents. Thirty-five (48.6%) consultations took place from Friday to Sunday, with no particular increase in the number of patients in specific time-periods. The medical consultations were mainly related to alterations in the level of consciousness 29 (40.3%) and agitation 19 (26.4%). In 12 (16.7%) cases the patients had also been known to have drunk alcohol, and 4 (5.6%) of them had also taken cocaine. In 42 (58.3%) occasions, patients were discharged to home, 20 (27.8%) were admitted to the hospital and 10 (13.9%) were referred to the outpatients' department for a follow-up. CONCLUSIONS: There was a predominance of teenage males in the consumption of cannabis. In many cases, there was a related psycho-social element to the use of the substance and those who consumed cannabis appeared in many cases to have consumed other drugs of abuse. There are still many patients who, after having checked into the Paediatric Emergency Department, show no record of having received a proper follow-up. We highlight the need to improve this aspect.

Diagnóstico de disfunción valvular en la edad pediátrica: valor predictivo de los síntomas y signos clínicos / Diagnosis of Valve dysfuntion in the paediatric age: the predictive value of the clinical sigsn and symptoms

Introducción. Las válvulas de derivación de líquido cefalorraquídeo son el tratamiento de elección en muchos delos casos de hidrocefalia infantil. La disfunción de las válvulas de derivación de líquido cefalorraquídeo habitualmente sepresenta de forma inespecífica, por lo que su diagnóstico se ve retrasado, lo que puede aumentar la morbimortalidad de estospacientes. Objetivo. Determinar los síntomas y signos más sugestivos de disfunción valvular en la población infantil. Pacientesy métodos. Estudio retrospectivo de los informes de los pacientes que consultaron al servicio de urgencias de un hospitalpediátrico de tercer nivel con clínica sugestiva de disfunción valvular. Se determinan en cada caso las manifestaciones clínicas,así como el diagnóstico o no de disfunción valvular. Se realiza un análisis univariante y posteriormente un estudio medianteregresión logística. Resultados. Se incluyeron 183 consultas. Se confirmó disfunción valvular en el 28,5%. La complicaciónmás frecuente fue la obstrucción del catéter de drenaje proximal. El análisis univariante demostró una relación significativaentre la presencia de irritabilidad, somnolencia, dolor abdominal, paresia de pares craneales y aumento del perímetrocraneal con la existencia de disfunción valvular. El modelo de regresión logística constató que somnolencia, irritabilidady dolor abdominal podían predecir disfunción valvular. Conclusiones. La somnolencia y la irritabilidad son las manifestacionesclínicas que mejor predicen una disfunción valvular, por lo que parece indiscutible que sean candidatas a estudio neurorradiológicourgente. El dolor abdominal se relaciona en la mayoría de casos con pseudoquistes abdominales. La cefalea, losvómitos y la fiebre son menos predictivos de disfunción valvular (AU)

Introduction. Cerebrospinal fluid shunt valves are the preferred treatment in many cases of childhood hydrocephalus.Cerebrospinal fluid shunt valve dysfunctions usually present in an unspecific manner, which delays their diagnosisand, consequently, can increase the morbidity and mortality rates in these patients. Aim. To determine the signs and symptomsthat are most suggestive of valve dysfunction in the childhood population. Patients and methods.We conducted a retrospectivestudy of the reports of patients who visited the emergency department of a tertiary care paediatric hospital with a clinicalpicture that suggested valve dysfunction. In each case the clinical manifestations were determined, and also whether there hadbeen a diagnosis of valve dysfunction or not. A univariate analysis and later a logistic regression study were performed.Results. In all, 183 visits were included. Valve dysfunction was confirmed in 28.5% of them. The most frequent complicationwas obstruction of the proximal drainage catheter. The univariate analysis showed a significant relation between the presenceof irritability, sleepiness, abdominal pain, paresis of the cranial nerves and increased perimeter of the skull, and the existenceof valve dysfunction. The logistic regression analysis revealed that sleepiness, irritability and abdominal pain could predictvalve dysfunction. Conclusions. Sleepiness and irritability are the clinical manifestations that best predict valve dysfunction,which means that they are almost undoubtedly candidates for an urgent neuroimaging study. In most cases the abdominal painis related to abdominal pseudocysts. Headaches, vomiting and a high temperature are less predictive of valve dysfunction (AU)

[Diagnosis of valve dysfunction in the paediatric age: the predictive value of the clinical signs and symptoms]. / Diagnóstico de disfunción valvular en la edad pediátrica: valor predictivo de los síntomas y signos clínicos.

INTRODUCTION: Cerebrospinal fluid shunt valves are the preferred treatment in many cases of childhood hydrocephalus. Cerebrospinal fluid shunt valve dysfunctions usually present in an unspecific manner, which delays their diagnosis and, consequently, can increase the morbidity and mortality rates in these patients. AIM: To determine the signs and symptoms that are most suggestive of valve dysfunction in the childhood population. PATIENTS AND METHODS: We conducted a retrospective study of the reports of patients who visited the emergency department of a tertiary care paediatric hospital with a clinical picture that suggested valve dysfunction. In each case the clinical manifestations were determined, and also whether there had been a diagnosis of valve dysfunction or not. A univariate analysis and later a logistic regression study were performed. RESULTS: In all, 183 visits were included. Valve dysfunction was confirmed in 28.5% of them. The most frequent complication was obstruction of the proximal drainage catheter. The univariate analysis showed a significant relation between the presence of irritability, sleepiness, abdominal pain, paresis of the cranial nerves and increased perimeter of the skull, and the existence of valve dysfunction. The logistic regression analysis revealed that sleepiness, irritability and abdominal pain could predict valve dysfunction. CONCLUSIONS: Sleepiness and irritability are the clinical manifestations that best predict valve dysfunction, which means that they are almost undoubtedly candidates for an urgent neuroimaging study. In most cases the abdominal pain is related to abdominal pseudocysts. Headaches, vomiting and a high temperature are less predictive of valve dysfunction.

[Acute ethanol intoxication in a paediatric emergency department]. / Consultas por intoxicación etílica aguda en un servicio de urgencias pediátricas.

INTRODUCTION AND AIM: Patients arriving in Paediatric Emergency Departments due to alcohol abuse is fairly common. The aim of this study is to determine the profile of the patients seen in the emergency room for acute ethanol intoxication. MATERIAL AND METHOD: A descriptive study was performed on all patients seen in the emergency department with an acute ethanol intoxication over a 12-month period (2007). Patients with accidental poisoning or with related chronic illness were excluded. RESULTS: A total of 104 patients were included (50% males). Their mean age was 16.2 years (standar desviation [SD] 1.2 years); 95.8% were older than 14 years. There was on patient who was seen twice for the same reason. The majority, 72.4%, were seen on holiday days; 82.9%, from 8:00 pm to 8:00 am. A total of 81.9% of the patients were brought in by ambulance. No cases of hypoglycaemia were detected and 7.5% of the patients had hypothermia. Ethanol levels and urine toxicology were measured in 66 cases. The mean blood ethanol was 186.1mg/dl (SD 56.2mg/dl); 21.2% were slightly intoxicated, 75.8% moderate and 3% severe. Cannabis was detected in seven cases and amphetamines in three. Three patients needed hospital admission. CONCLUSIONS: The profile of the patient who arrives to emergency department with acute ethanol intoxication is a teenager who is seen on holiday nights, after a consumption of high proof alcoholic drinks, presents a moderate intoxication, and does not require hospitalisation.

Consultas por intoxicación etílica aguda en un servicio de urgencias pediátricas / Acute ethanol intoxication in a paediatric emergency department

Introducción y objetivo: las consultas por consumo abusivo de alcohol se están volviendo habituales en los Servicios de Urgencias Pediátricas. El objetivo de este trabajo es determinar el perfil de los sujetos atendidos en Urgencias por intoxicación etílica aguda (IEA). Métodos: estudio descriptivo de los sujetos a los que se atendió por IEA en Urgencias durante el año 2007. Se excluyó a aquellos sujetos con intoxicación accidental o con enfermedad crónica asociada. Resultados: se incluyó a 104 sujetos (el 50% eran varones) con una media de edad de 16,2 años (desviación estándar [DE] de 1,2 años); el 95,8% era mayor de 14 años. A un sujeto se lo atendió en 2 ocasiones por el mismo motivo. El 72,4% de las consultas fueron en festivos; el 82,9% se realizaron de 20.00 a 8.00. El 81,9% de los sujetos acudió en ambulancia. No se detectó ningún caso de hipoglucemia y un 7,5% de los casos presentó hipotermia. Se determinó la concentración de etanol y tóxicos en orina en 66 consultas. La media de etanol en sangre fue de 186,1mg/dl (DE de 56,2mg/dl): el 21,2% presentó intoxicación leve, el 75,8% presentó intoxicación moderada y el 3% presentó intoxicación grave. Se detectó consumo de cannabis en 7 casos y consumo de anfetaminas en 3 casos. Tres sujetos requirieron ingreso. Conclusiones: el perfil del sujeto que acudió a Urgencias por IEA fue el de un adolescente que consulta las noches de festivos tras el consumo de una bebida alcohólica de alta graduación, que presenta una intoxicación moderada y que no requiere hospitalización (AU)

Introduction and aim: Patients arriving in Paediatric Emergency Departments due to alcohol abuse is fairly common. The aim of this study is to determine the profile of the patients seen in the emergency room for acute ethanol intoxication. Material and method: A descriptive study was performed on all patients seen in the emergency department with an acute ethanol intoxication over a 12-month period (2007). Patients with accidental poisoning or with related chronic illness were excluded. Results: A total of 104 patients were included (50% males). Their mean age was 16.2 years (standar desviation [SD] 1.2 years); 95.8% were older than 14 years. There was on patient who was seen twice for the same reason. The majority, 72.4%, were seen on holiday days; 82.9%, from 8:00 pm to 8:00 am. A total of 81.9% of the patients were brought in by ambulance. No cases of hypoglycaemia were detected and 7.5% of the patients had hypothermia. Ethanol levels and urine toxicology were measured in 66 cases. The mean blood ethanol was 186.1mg/dl (SD 56.2mg/dl); 21.2% were slightly intoxicated, 75.8% moderate and 3% severe. Cannabis was detected in seven cases and amphetamines in three. Three patients needed hospital admission. Conclusions: The profile of the patient who arrives to emergency department with acute ethanol intoxication is a teenager who is seen on holiday nights, after a consumption of high proof alcoholic drinks, presents a moderate intoxication, and does not require hospitalization (AU)

Efectos de citalopram, reboxetina y nefazondona sobre diversas preparaciones de órgano aislado de cobaya y de rata "in vitro" / Effectos of citalopram, reboxetine and nefazodone in differentes tissues form guinea-pig and rat "in vitro"

El citalopram, la reboxetina y la nefazodona son fármacos antidepresivos que fundamentalmente inhiben la recaptación neuronal de serotonina, aunque se han descrito otras interacciones. Se estudian los efectos de citalopram, reboxetina y nefazodona sobre noradrenalina (NA), dopamina (DA) o potasio (K+) en conducto deferente de rata; histamina (H), acetilcolina (Ach), 4-aminopiridina (4-AP) y potasio en ileon aislado de cobaya y serotonina (5-HT), oxitocina y potasio en útero aislado de rata. Se utilizó solución de Krebs-Henseleit con o sin adición de cocaína, 17-beta estradiol y propranolol, para el conducto deferente aislado de rata, solución de Jalón para el útero de rata y solución de Tyrode para el ileon aislado de cobaya. Cuando fue posible se calcularon los valores de pD'2. CONCLUSIONES: El citalopram inhibe las contracciones inducidas por Ach (pD'2 = 4.3 ± 0.3), H (pD'2 = 5.3 ± 0.4), 4-AP (pD'2 = 5.4 ± 0.4) y potasio (pD'2 = 4.3 ± 0.3) en ileon aislado de cobaya; 5-HT (pD'2 = 3.5 ± 0.3), oxitocina (pD'2= 4.8 ± 0.3) y potasio (pD'2= 4.2 ± 0.3) en útero de rata. La reboxetina inhibe las contracciones inducidas por 5-HT (pD'2= 5.1 ± 0.4), oxitocina (pD'2= 4.9 ± 0.3) y potasio (pD'2= 5.1 ± 0.4) en útero de rata y DA (pD'2= 4.6 ± 0.4 en conducto deferente aislado de rata. La nefazodona inhibe las contracciones inducidas por Ach (pD'2= 5.3 ± 0.3), H (pD'2 = 5.3 ± 0.4), 4-AP (pD'2 = 5.2 ± 0.3) y potasio (pD'2 = 5.2 ± 0.4) en ileon aislado de cobaya; 5-HT (pD'2 = 7.0 ± 0.5), oxitocina (pD'2 = 5.2 ± 0.4) y potasio (pD'2 = 5.2 ± 0.4) en útero de rata; NA (pD'2 = 2.4 ± 0.1), DA (pD'2 = 5.2 ± 0.4) y potasio (pD'2 = 4.4 ± 0.4) en conducto deferente aislado de rata. Otras interacciones no son estadísticamente significativas (AU)

Citalopram, reboxetine and nefazodone are antidepressants which mainly inhibit serotonin (5-HT) reuptake, other interactions have been described. Therefore, the effects of citalopram, reboxetine and nefazodone on noradrenaline (NA), dopamine (DA), or K+ - contracted rat vas deferens have studied. The effects on 5-HT, oxytocin and K+-induced contractions in rat uterus and those on histamine (H), acetylcholine (Ach), 4-aminopyridine (4-AP) and K+-contractions in guinea-pig ileum were also studied. Krebs-Henseleit solution with and without adding cocaine, 17 beta estradiol and propranolol was used for rat vas deferens tissues. Jalon solution for rat uterus and Tyrode solution for guinea-pig ileum. When possible pD'2 values were calculated. CONCLUSIONS: Citalopram inhibited contractions induced by Ach (pD'2 = 4.3 ± 0.3), H (pD'2 = 5.3 ± 0.4), 4-AP (pD'2 = 5.4 ± 0.4), and potassium (pD'2 = 4.3 ± 0.3) in guinea-pig ileum; 5-HT (pD'2 = 3.5 ± 0.3), oxytocin (pD'2 = 4.8 ± 0.3) and potassium (pD'2 = 4.2 ± 0.3) in rat uterus. Reboxetine inhibited contractions induced by 5-HT (pD'2 = 5.1 ± 0.4), oxytocin (pD'2 = 4.9 ± 0.3) and potassium (pD'2 = 5.1 ± 0.4) in rat uterus; DA (pD'2 = 4.6 ± 0.4) in rat vas deferens. Nefazodone inhibited contractions induced by Ach (pD'2 = 5.3 ± 0.3), H (pD'2 = 5.3 ± 0.4), 4-AP (pD'2 = 5.2 ± 0.3) and potassium (pD'2 = 5.2 ± 0.4) in guinea-pig ileum; 5-HT (pD'2 = 7.0 ± 0.5), oxytocin (pD'2 = 5.2 ± 0.4), and potassium (pD'2 = 5.2 ± 0.4) in rat uterus; NA pD'2 = 2.4 ± 0.1), DA (pD'2 = 5.2 ± 0.4) and potassium (pD'2 = 4.4 ± 0.4) in rat vas deferens. Other interactions were not statistically significant (AU)

[Violence and adolescence. A perspective from and Emergency Department]. / Violencia y adolescencia. Perspectiva desde un servicio de urgencias.

INTRODUCTION AND AIM: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department. MATERIAL AND METHOD: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed. RESULTS: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work. CONCLUSIONS: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society.

Violencia y adolescencia. Perspectiva desde un servicio de urgencias / Violence and adolescence. A perspective from and Emergency Department

Introducción y objetivo: Los actos de violencia entre adolescentes son cada vez más frecuentes y generan problemas de índole diversa. El conocimiento de las circunstancias que los rodean es importante para instaurar medidas que disminuyan su incidencia. El objetivo de este trabajo es analizar las características de las víctimas de agresiones atendidas en nuestro servicio de urgencias. Material y método: Estudio retrospectivo de los informes de urgencias de los adolescentes que fueron visitados en el año 2006 por haber sido agredidos y en los que se emitió un parte de lesiones. Resultados: Fueron 105 pacientes, con una edad media de 15,9 años (DE: 1,4 años) y predominio masculino (77 casos, 73,3 %). El 55,2 % de las visitas se produjeron entre las 20.00 y las 4.00 h; el 58,1 % en día festivo. El motivo de la consulta estaba relacionado con una pelea en 49 casos (46,7 %), con una agresión sin pelea en 44 (41,9 %), con maltrato físico en 7 (6,7 %) y con abuso sexual en 5 (4,8 %). En el 85,1 % se había usado la fuerza física; en el 13,3 %, instrumentos no cortantes, y en el 5,7 %, armas blancas. Las contusiones fueron las lesiones más frecuentes, en 98 pacientes (93,3 %), seguidas de heridas abiertas y fracturas, en 20 (19 %) y 12 casos (11,4 %), respectivamente. Requirieron pruebas de radiodiagnóstico 62 adolescentes (59 %), análisis de orina 10 (9,5 %) y hemograma 7 (6,7 %). Ingresaron 7 pacientes (6,7 %) y 6 (5,7 %) fueron valorados por Trabajo Social. Conclusiones: El conocimiento de la epidemiología de este problema y su difusión entre los profesionales implicados en su manejo debe promover la creación de protocolos y acciones coordinadas que puedan minimizar su impacto entre los adolescentes y, por lo tanto, en la sociedad

Introduction and aim: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department. Material and method: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed. Results: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work. Conclusions: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society

Abuso sexual infantil. Características de las consultas y manejo desde el servicio de urgencias / Child sexual abuse. Patient characteristics and management from the emergency department

Introducción: Los conflictos familiares podrían ser una de las causas del incremento delas consultas a urgencias por sospecha de abuso sexual. El objetivo de este trabajo es describir las características de los niños valorados en urgencias por sospecha de abusosexual. Método: Revisión retrospectiva de los casos valorados durante los primeros 7 meses de2004.Resultados: Se atendieron 48 consultas, dos por abuso agudo. La edad media fue de6,8 (SD 3,6 años), 42 fueron niñas. En el 85,4% la exploración física fue normal. Se completó el estudio en la Unidad multidisciplinar específica en 37 pacientes, 25 tenían a los padres separados. En 10 niñas el diagnóstico fue de abuso. Todos los agresores fueron hombres, principalmente familiares. No se hallaron diferencias entre la conclusión de abuso y el sexo del paciente, la presencia de una exploración física normal y la situación de separación de los padres. Conclusiones: En urgencias es difícil evaluar adecuadamente las consultas por abuso sexual. La mayoría no requieren actuación inmediata, y es imprescindible la actuación coordinada con Unidades multidisciplinares especializadas, que confirman un tercio delos casos. Las niñas son las principales víctimas y el agresor, una persona conocida (AU)

Background: Family conflicts may be one of the reasons for the increase in visits for suspected child sexual abuse in Emergency Departments. The aim of the study was to report the characteristics of the children who present to Emergency Department with suspected sexual abuse. Methods: Retrospective review of all the children evaluated for suspected sexual abuse in the Emergency Department during the first seven months of 2004.Results: A total of 48 patients were attended two for acute sexual abuse. The mean age was 6.8 years (SD 3.6 years),42 were girls. Physical examination was normal in 85.4%. The study was completed in the Multidisciplinary Abuse Unit in 37 patients; 25 of when had divorced parents. In 10 girls sexual abuse was established. All rapists were men, mainly relatives of the children. No differences were found in the diagnoses of abuse, patient sex, normal physical examination or the divorced state of the parents. Conclusions: Confirmation of suspected sexual abuse in the Emergency Department is difficult. Most cases do not require immediate intervention and cooperation with a Multidisciplinary Abuse Unit is necessary. One third of child abuse suspicions are confirmed. The victims are mainly girls and the aggressors are usually persons close to the children (AU)

Costs and outcomes of total hip and knee joint replacement for rheumatoid arthritis.

The objective of the study was to ascertain costs and outcomes of total joint replacement surgery for rheumatoid arthritis (RA) in Australia from the patients' perspective and to explore whether costs were affected by health status pre- or postsurgery. RA patients, scheduled for primary unilateral total knee replacement (TKR) or total hip replacement (THR) surgery at five Sydney hospitals, were approached. Preoperatively, patients retrospectively recorded expenses incurred over the previous 3 months and the health assessment questionnaire (HAQ). Postoperatively, patients completed detailed prospective cost diaries, short form (SF) 36, and HAQ every 3 months during the first postoperative year. In addition, patients were asked to complete a visual analogue measure for pain at 12 months postsurgery. Arthritis-specific cost information included prescription and nonprescription medication, visits to health professionals, tests, special equipment, alterations to the house, and use of private or community services. Thirty-one TKR and 11 THR patients provided cost data for the first postoperative year. Out-of-pocket costs and service utilization decreased over the first postoperative year for both TKR and THR patients. In addition, there was an improvement in the health status as measured by SF-36 but not the HAQ at 3 and 12 months postoperatively. The small sample size of this analysis is reflective of the current national trends of RA joint replacement surgery. Despite the low incidence of RA joint replacement surgery, it was substantiated that patients consider the positive impact on health outcomes and costs important. The generic SF-36 detected improvements in the health status of these RA patients, while total HAQ scores failed to do so. HAQ was found to be insensitive in reflecting improvements following lower limb replacement surgery. Patient out-of-pocket costs significantly decreased postoperatively; however, these costs remain substantial compared to osteoarthritis total joint replacement patients.

[Neonatal management in the emergency department of a tertiary children's hospital]. / Asistencia a neonatos en el servicio de urgencias de un hospital pediátrico terciario.

OBJECTIVE: To determinate the chief complaints in neonates presenting to a pediatric emergency service and their management. MATERIAL AND METHODS: We performed a retrospective study of patients younger than 28 days old who presented to the pediatric emergency department in 2003. Patients directly admitted to the neonatal unit and those attended by the surgery and orthopedic surgery departments were excluded. Information on sex, age, time and date, waiting time, visit duration, source of referral, presenting complaint, complementary examinations, final diagnosis, and hospital admission were analyzed. RESULTS: There were 1,481 neonatal visits. The mean chronological age was 15.8 days and 57.3 % were boys. Visits were most frequent on Fridays, evening shifts, and in July and December. The most frequent chief complaints were crying/irritability (16.3 %), fever (13.6 %), vomiting (11 %), and influenza (10.8 %). The most frequent final diagnoses were feeding problems (12.6 %), infantile colic (12.4 %), and upper respiratory tract infections (12 %). No abnormalities were detected in 11.7 % of the patients and complementary examinations were not required in 45.9 %. The admission rate was 26 %, most commonly due to fever and bronchiolitis. CONCLUSIONS: Many visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care. Because of the greater vulnerability of this age group, thorough investigation is required to rule out severe disease. This phenomenon was reflected by the large number of complementary examinations and admissions.