Fiebre en Urgencias: detección de patología grave / Fever in Emergency Department: screening for severe disease

Fundamento y objetivo. Conocer las variables que se asocian a la patología grave en los pacientes adultos con fiebre en Urgencias. Material y métodos. Estudio prospectivo observacional. Se recogieron datos de todos los pacientes adultos con fiebre (temperatura axilar superior a 37,7 °C) atendidos en el área médica del Servicio de Urgencias de nuestro hospital entre el 28 de enero al 30 de abril de 2006. Las variables recogidas se incluyeron en un análisis de regresión logística, siendo la variable dependiente principal «enfermedad grave». En función del riesgo correspondiente se asignó una puntuación a cada variable que permitiera diseñar una escala de riesgo de enfermedad grave. Resultados. Se atendieron 11.271 pacientes, de los cuales 786 tenían fiebre (7,0%). La edad media fue 39 años (37-40), 57% varones, 13% inmigrantes. Ingresaron un 31% y presentaron patología grave un 27%. En función de los datos clínicos se sospechó focalidad respiratoria alta en 309 (39%) y baja en 130 (17%), foco abdominal en 117 (15%), foco urinario en 40 (5%) y sin foco aparente en 145 (18%). Se asociaron a patología grave comorbilidad (odds ratio [OR] 3,6; intervalo de confianza [IC]95% 1,8-7,2) (4 puntos), proteína C reactiva (PCR) superior a 10 mg/dl (OR 1,8; IC95% 1,1-3,7) (2 puntos), edad (OR 1,02; IC95% 1,01-1,04) (edad superior a 60 años 3 puntos) y fue factor protector la fiebre de probable origen respiratorio alto (OR 0,4; IC95% 0,2-0,9) (fiebre de otro foco 3 puntos). Tenían patología grave el 3% de los pacientes con menos de 3 puntos y el 72% de los que tenían más de 7 puntos. Conclusiones. En los adultos con fiebre en Urgencias la presencia de comorbilidad, un nivel de PCR superior a 10mg/dl, la focalidad diferente a una infección de las vías respiratorias altas y la edad se asociaron a una patología grave (AU)

Background. To identify variables associated to severe disease in adult patients with fever in the Emergency Department. Material and methods. Observational, perspective study. Data from all the adult patients with fever (axillary temperature 37.8 °C or higher) seen in the medical area of the Emergency Department was collected from January 28th to April 30th of 2006 and included in a logistic regression analysis, the dependent variable being «severe disease». Based on the corresponding risk, a score was assigned to each variable to design a risk of severe disease model. Results. A total of 11271 patients were seen, 786 (7.0%) of whom had fever. Median age was 39 years (37-40), 57% male. Of these, 31% were admitted and 27% had severe disease. Based on the symptoms and signs, upper airways infection was suspected in 309 (39%) and lower airways infection in 130 (17%), abdominal infection in 117 (15%), urinary tract infection in 40 (5%) and no source of infection in 145 (18%). Comorbidity (OR 3.6, 95% CI -1.8-7.2) (4 points), C-reactive protein higher than 10 mg/dl (OR 1.8, 95% CI 1.1-3.7) (2 points) and age (OR 1.02, 95% CI 1.01-1.04) (age older than 60 years 3 points) were associated with severe disease. Fever having a probable upper respiratory origin was a protector factor (OR 0.4, 95% CI 0.2-0.9) (fever from other foci 3 points). Three percent of the patients with less than 3 points had severe disease versus 72% with more than 7 points. Conclusions. Comorbidity, C-reactive protein higher than 10 mg/dl, age and suspicion of source of infection different of upper airways infection were associated to severe disease in adults with fever in the Emergency Department (AU)

Meningitis por Listeria monocytogenes tras colonoscopia en paciente con infección por VIH y citomegalovirus / Listeria monocytogene' s meningitis in a HIV and CMV patient after colonoscopy

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[Infectious pathology in diabetic patients cared for in an emergency department]. / Patología infecciosa en pacientes diabéticos atendidos en un departamento de urgencias.

OBJECTIVE: We study the influence of diabetes in the incidence of infectious diseases attended in an emergency department (ED). PATIENTS AND METHODS: 2,500 adult patients attended in the ED of a general hospital were examined. We value prospectively: clinical data, diagnosis in ED and rate of admissions, comparing two groups: Group A (175 diabetic patients), Group B (350 non diabetic control patients, with the same age and sex). We used the glycated Hb and the glucose levels to make a difference in A Group: patients with good control (A1 = Hb A1c < 8), patients with poor control (A2 = HbA1c > 8), patients with low glucose levels (A3 = glucose < 200 mg/dl) and high glucose levels (A4 = glucose > 200 mg/dl). RESULTS: Infectious disease are more frequent in diabetic patients than no diabetic (Group A = 13.1% vs Group B = 3.2%), certain amount pneumonia and urinary tract infection. Also the infectious diseases are more frequent in diabetic patients with high glucose levels (Group A4) than diabetic patients with low glucose levels (Group A3), but there were no significant differences between A1 and A2 groups. CONCLUSIONS: The presence of diabetes was bound up with a higher frequency of infectious diseases, above all pneumonia and urinary tract infection, in an ED. The importance of metabolic control in relation with infectious diseases is not definite in our study.

Patología infecciosa en pacientes diabéticos atendidos en un departamento de urgencias / Infectious diseases in diabetic patients attended in an emergency department

Objetivo: Valoramos la importancia de la presencia de diabetes en relación con los procesos infecciosos habituales diagnosticados entre los pacientes atendidos en un Departamento de Urgencias. Material y métodos: Se valoraron prospectivamente 2.500 pacientes adultos que acudieron a un Servicio de Urgencias de un hospital general de un área urbana. Analizamos antecedentes personales, motivos de consulta, diagnóstico en urgencias y necesidad de hospitalización comparando dos grupos: pacientes diabéticos (Grupo A=175) y grupo control de pacientes no diabéticos (Grupo B= 350, con la misma edad y sexo). Utilizando como parámetros de control metabólico la Hemoglobina glicosilada (Hb A1c) y la glucemia diferenciamos dentro de los pacientes diabéticos cuatro subgrupos: pacientes con buen control metabólico (A1= HbA1c8), pacientes con glucemia inferior a 200 mg/dl (A3) y superior a 200 mg/dl (A4). Resultados: Las infecciones fueron más frecuentes entre los pacientes diabéticos que en los no diabéticos (Grupo A= 13,1 porciento vs Grupo B=3,3 porciento), tanto en el caso de las neumonías como en las infecciones urinarias. Asimismo fueron más frecuentes los procesos infecciosos entre los pacientes diabéticos con glucemias elevadas (grupo A4), mientras que no encontramos diferencias significativas entre los subgrupos A1 y A2 respecto a estas entidades. Conclusiones: En nuestro estudio la presencia de diabetes se asoció a una mayor frecuencia de infecciones comunes frente a la población no diabética atendida en un Servicio de Urgencias. No fueron concluyentes los resultados en cuanto a la relación entre enfermedades infecciosas y control metabólico de los pacientes diabéticos (AU)

[Complications of intestinal transporting of cocaine packets. Study of 215 cases]. / Complicaciones en transportadores intestinales de paquetes con cocaína. Estudio de 215 casos.

BACKGROUND: To analyse clinical manifestations, diagnosis and management in the "body packer syndrome". MATERIAL AND METHODS: We collected 215 patients who had ingested packets of cocaine. RESULTS: Bowel obstruction, haemorrhagic complications and seizures were observed in 5.1, 4.2 and 2.3%, respectively. Toxic manifestations of cocaine occurred in 4 patients. CONCLUSIONS: Radiographs of abdomen are necessary for diagnosis and follow-up. Close surveillance in necessary to identify intestinal obstruction or acute intoxication by cocaine.

[Alcohol withdrawal syndrome: clinical and analytical manifestations and treatment]. / Síndrome de abstinencia alcohólica: manifestaciones clínicas, analíticas y tratamiento.

BACKGROUND: The aim of this study was to analyze clinical manifestations and treatment aspects of alcohol withdrawal syndrome. MATERIAL AND METHODS: A retrospective study of 212 clinical records. RESULTS: The commonest withdrawal effects were tremulousness (68.7%) 7 agitation (67.3%) and hallucinations (46%). Most patients were male. The 64% recognize a period of relative or absolute abstinence less than two days, and a 67.8% have been previous incident of withdrawal syndrome. The commonest complications during hospital stay were rhabdomyolysis (26%). Time of symptoms were three days and mean of hospitalization were 14 days. The treatment used was the correction of fluid and electrolyte imbalance (93%) and B vitamins (98%). In relation to the use of drugs, in 84% of our patients we used benzodiazepines with longer-acting, and clomethiazole in 50% of cases. Mortality were 0.9%. CONCLUSIONS: Patient with alcohol withdrawal syndrome was a male, previously drinker, with a period of abstinence less than two days. In addition to tremulousness and agitation, in our series, we wish to emphasize higher frequency of hallucinations, and the incidence of complications as rhabdomyolysis, despite of such response of treatment is good and mortality is low.