¿Es necesaria la industria farmacéutica en la actividad extraasistencial de los médicos de atención primaria? / Is the pharmaceutical industry necessary in the non-health care activities of primary care doctors?

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Atención del dolor abdominal en un Dispensario Extrahospitalario de Urgencias (DEHU) / Abdominal pain at an Extrahospitalary Emergency Dispensary (EHED)

Objetivo: Analizar las características clínicas y evolutivas de los pacientes que acuden por dolor abdominal a nuestro Dispensario Extrahospitalario de Urgencias (DEHU), así como estudiar el funcionamiento del centro a través del flujo de pacientes que acuden por dolor abdominal como motivo principal de consulta. Métodos: Se analizaron 339 pacientes que acudieron a nuestro DEHU de forma consecutiva durante 3 meses. En todos los pacientes se analizó su procedencia, se realizó una anamnesis y exploración física, y en los que se consideró indicado se realizaron exploraciones complementarias (hemograma, bioquímica, tira reactiva de orina y radiografía simple). Los pacientes que requirieron de otras pruebas fueron remitidos al hospital de referencia. En todos los casos se realizó un diagnóstico clínico y en 248 de ellos, un control telefónico posterior al alta. Resultados: El 41 por ciento de los pacientes acudieron por iniciativa propia, el 51 por ciento fueron derivados por el servicio de urgencias hospitalarias y el 8 por ciento, por el médico de Atención Primaria. Los diagnósticos principales finales fueron: dolor abdominal inespecífico (36 por ciento), gastroenteritis aguda (23 por ciento), dispepsia ulcerosa (17 por ciento), e infección de vías urinarias (6 por ciento). El diagnóstico inicial coincidió con el final en 240 (96 por ciento) de los 248 pacientes entrevistados. De los pacientes en los que se procedió al alta domiciliaria (94 por ciento), el 93 por ciento siguieron control por el médico de AP, y el 7 por ciento restante por el especialista. Requirieron derivación al servicio de urgencias de nuestro hospital 21 pacientes (6 por ciento). Conclusiones: Un tercio de los pacientes que consultan por dolor abdominal lo hacen por dolor abdominal inespecífico, y evolucionan correctamente con tratamiento sintomático. Sólo el 6 por ciento de los pacientes requieren derivación hospitalaria. La capacidad resolutiva mostrada en los pacientes atendidos por dolor abdominal demuestra la utilidad sanitaria de nuestro DEHU (AU)

[Flubiprofen vs dipyrone combined with hyoscine: the analgesic efficacy in renal colic]. / Flubiprofeno vs dipirona asociada a hioscina: eficacia analgésica en el cólico nefrítico.

OBJECTIVE: We compared the efficacy of flurbiprofen (NSAID) versus dipirone + hyoscine N-butylbromide in the treatment of nephric colic. METHODS: The study comprised 135 patients, aged 18 to 75 yrs, with intense nephric colic. The patients were observed 60 min after a single IM dose of 150 mg flurbiprofen (n = 67) or 2 gm dipirone + 20 mg hyoscine N-butylbromide. RESULTS: Both treatment modalities were well-tolerated and afforded significant pain relief. Flurbiprofen, however, was faster-acting and superior to dipirone + hyoscine in the overall evaluation of good and excellent therapeutic response rates. CONCLUSION: The results of the study show that IM flurbiprofen is a useful alternative to dipirone + hyoscine N-butylbromide in the treatment of nephric colic.

[The efficacy of injectable flurbiprofen in the symptomatic treatment of biliary colic]. / Eficacia del flurbiprofeno inyectable en el tratamiento sintomático del cólico biliar.

BACKGROUND: To evaluate the efficacy of flurbiprofen (nonsteroidal anti-inflammatory drug) in the treatment of biliary colic pain as compared with the drugs commonly used (analgesics and/or spasmolytics). METHODS: Eighty-four patients aged between 21 and 86 affected by intense pain of simple hepatic colic participated in the study. Following a single intramuscular dose of 150 mg of flurbiprofen (FRI, n = 30), 20 mg of N-hyoscine butylbromide (HBB, n = 25) or 30 mg of pentazocine (PTZ, n = 29) the patients were observed during the 6 hours after administration. RESULTS: The evolution of the pain was significantly better in the patients treated with FRI with differences being detected between the three drugs after 30 minutes of administration. A greater number of adverse reactions were seen among the patients who received PTZ with the differences being statistically significant with the other 2 treatments (p less than 0.02). CONCLUSIONS: Intramuscular flurbiprofen was more effective and generally better tolerated than pentozocine and hyoscine butylbromide.

[Hypoglycemia: a prospective study in an emergency service]. / Hipoglucemia: estudio prospectivo en un servicio de urgencias.

Hypoglycemia is a frequent clinical situation of particular interest in an emergency department because of its potential gravity and the need for quick and effective treatment. We present a prospective study of 50 patients with hypoglycemia detected in the emergency department. These being 0.17% of all the consultations in this period. The administration of an incorrect doses of insulin was the most frequent cause of hypoglycemia. We observed a good correlation between the BM-test and posterior glycemia. The patients who had initial neurologic symptoms had the lowest levels of glycemia, required more time for recovering and needed more glucose. 20 patients had high levels of glycemia 11.14 mmol/L. This fact was correlated with the amount of glucose administered. The authors suggest 50 g of glucose as the limit for administration, with the possible exception of patients with neurological symptoms.

[Acute appendicitis in the elderly (author's transl)]. / Apendicitis aguda en el viejo.

The mortality rate and clinical, analytical, radiographic and pathologic data from 31 patients with acute appendicitis over 60 years of age are compared to those from 100 patients under 60. The elderly group showed a greater delay in medical consulting, a more diffuse abdominal pain and a greater incidence of perforated and gangrenous appendicitis. This last fact could be related not only to the consulting delay, but also to the own characteristics of the aged appendix. There were no significant differences between both groups regarding analytical results and radiographic findings. Mortality rate was 13 percent in the elderly, while it was null in the younger series.

[Acute abdomen in the elderly: etiology, complications, and prognosis. A review of 100 cases (author's transl)]. / Abdomen agudo en el viejo: etiología, complicaciones y pronóstico. A propósito de 100 casos.

One hundred cases of acute abdomen in patients over 70 years of age were studied. Mechanical occlusion was the most common cause among these patients, as opposed to acute appendicitis, which is the primary cause of the same condition among young people and adults. Irreducible hernias and visceral neoplasias were the most frequent etiologies among cases of mechanical occlusion. Cholecystitis took second place in our series. Visceral peforations were more often due to localized infections or visceral neoplasias than to gastric or duodenal ulcers. Overall mortality among these patients was 29 percent. Patients with visceral perforations due to localized infections or visceral neoplasias and all of the patients with vascular diseases had a negative prognosis.