Análisis del patrón de consumo de psicotropos y drogas de abuso en el hospital de Pontevedra durante el año 2016 / Analysis of the pattern of psichotropic and drug abuse in Pontevedra hospital during 2016

Estudio descriptivo retrospectivo de las intoxicaciones agudas por psicofármacos y/o drogas de abuso atendidas en el servicio de urgencias del hospital de Pontevedra durante el año 2016 con el fin de conocer el tipo de intoxicación, su intencionalidad, cronología, agentes tóxicos implicados, antecedentes de los pacientes, manifestaciones clínicas presentadas, evolución y tratamiento administrado. Se realizó la prueba cualitativa Drug-Clip Test 10 (A. Menarini Diagnostics) en orina. Se confirmaron 831 resultados positivos (1% de las urgencias anuales). Las intoxicaciones por benzodiazepinas fueron las más frecuentes (617 casos), principalmente en mujeres, seguidas de la detección de cannabis (318 casos), mayormente en hombres. Predominaron los síntomas neurológicos (44%), antecedentes psiquiátricos (43%) y el tratamiento inespecífico (82%). La intencionalidad autolítica fue del 22% y la mortalidad del 0,8%. Concluimos que la sobreprescripción de benzodiazepinas está aumentando su accesibilidad, causando un incremento de las intoxicaciones agudas y los intentos autolíticos por estos fármacos

Retrospective descriptive study of acute intoxications by psychotropic substances and/or abuse drugs at the emergency department of Pontevedra Hospital during the year 2016 performed to know the type of intoxication, its intention, chronology, toxic agents involved, previous patient history, clinical manifestations presented, evolution and treatment administered. The Drug-Clip test 10 (A. Menarini diagnostics) was tested in urine. Results. 831 positive cases were confirmed (1% of the overall annual emergencies). Benzodiazepine intoxications were the most frequent (617 cases), mainly in women, followed by cannabis detections (318 cases), mostly in males. Neurological symptoms (44%), psychiatric antecedents (43%) and unspecific treatment (82%) predominated. Autolytic Intentionality was 22% and mortality 0.8%. Conclusion. Over-prescription of benzodiazepines makes easier its accessibility, causing an increase in the acute intoxications and the autolytic attempts by these drugs

Factors associated with diabetes mellitus among adults with tuberculosis in a large European city, 2000-2013.

BACKGROUND: Diabetes mellitus (DM) can contribute to the development of tuberculosis (TB). OBJECTIVE: To analyse the prevalence of DM and its associated factors among adults with TB in a large city in an industrialised country. METHODS: This is a population-based study in adults diagnosed with TB between 2000 and 2013 in Barcelona. We studied potentially associated sociodemographic and clinical/epidemiological factors. Logistic regression was used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Of 5849 TB patients, 349 (5.9%) had DM. The annual prevalence of DM ranged from 4.0% to 7.2%. Factors associated with DM were being Spanish-born (OR 1.46, 95%CI 1.11-1.96), age ⩾40 years (OR 6.08, 95%CI 4.36-8.66), cavitary patterns on chest X-ray (OR 1.42, 95%CI 1.08-1.86), experiencing more side effects due to anti-tuberculosis treatment (OR 1.86, 95%CI 1.28-2.64) and hospitalisation at the time of diagnosis (OR 1.8, 95%CI 1.40-2.31). Human immunodeficiency virus infection was associated with a lower probability of DM in both subjects with a history of injection drug use (OR 0.27, 95%CI 0.10-0.57) and those without (OR 0.04, 95%CI 0.002-0.19). CONCLUSIONS: DM prevalence among adults with TB in Barcelona is low and remained stable over the 14-year study period. However, TB patients with DM were potentially more infectious and their clinical management was more complicated.

Accurate topographical diagnosis of urinary tract infection in male patients with (111)indium-labelled leukocyte scintigraphy.

Background: Although the clinical diagnosis of urinary tract infection (UTI) is straightforward, the precise localization of the urogenital organ affected by the infection is often difficult to establish. Methods: To evaluate this, we prospectively studied 20 males with a clinical diagnosis of acute pyelonephritis (APN), acute prostatitis (AP) and febrile UTI (FUTI), as well as seven control females with APN. (111)Indium-labelled leukocyte scintigraphy (ILS) was performed during the febrile episode and repeated when patients were free of symptoms. Results: ILS showed an abnormal uptake in a urinary organ in every case. All patients with AP showed uptake in the pelvic area. Four male patients presented AP, one of them had uptake in the lumbar area, one in the lumbar and pelvic area, and two in the area of the prostate only. Six out of seven patients with FUTI presented uptake in the pelvic area. All female patients showed kidney uptake. After the clinical resolution of the UTI, no residual uptake was found in any case except for one. Conclusions: These results suggest that ILS is very useful in localizing the affected organ in febrile UTI. Most male patients with a febrile UTI presented a prostatic involvement, suggesting that many cases of APN or FUTI in males may actually be cases of AP not recognized by standard clinical evaluation.

Community-acquired febrile urinary tract infection in diabetics could deserve a different management: a case-control study.

OBJECTIVE: To investigate if there are relevant differences in clinical, microbiological and outcome characteristics of community-acquired febrile urinary tract infection (UTI) between diabetic and nondiabetic patients. DESIGN: A prospectively matched case-control study. SETTING: An 800-bed tertiary care university-affiliated hospital. SUBJECTS: A total of 108 patients (54 diabetic and 54 nondiabetic patients matched by age and gender) admitted between January 1996 and September 1999 with febrile UTI. METHODS: Clinical, analytical, microbiological and outcome variables were analysed by means of McNemar test (categorical) or Wilcoxon matched pairs signed rank test (continuous). RESULTS: Mean age (SD) in both groups was 67.9 (14.4) years. In comparison with controls, diabetic patients were more likely to have fever without localizing symptoms (27% vs. 9%, P

Decreased invasive capacity of quinolone-resistant Escherichia coli in patients with urinary tract infections.

Quinolone-resistant (QR) Escherichia coli may have lower invasive capacity than does quinolone-susceptible E. coli. To evaluate this, we prospectively collected data regarding all cases of E. coli invasive urinary tract infections (IUTI) in 669 adults admitted to the Infectious Diseases Unit of our hospital during a 3-year period, as well as 10,950 patients with cystitis or asymptomatic bacteriuria who presented to the outpatient clinic during a 1-year period. QR E. coli was isolated in 20% of patients with cystitis, compared with 8% of those with IUTI (P<.05). The proportion of E. coli isolates that were quinolone resistant was similar in patients with bacteremic and nonbacteremic IUTI. The factors of urinary manipulation and structural abnormalities were independently associated with the presence of quinolone resistance. Old age was the only variable independently associated with blood invasion. QR E. coli is less likely to produce invasive disease (pyelonephritis and prostatitis) than is quinolone-susceptible E. coli. However, once pyelonephritis or prostatitis have developed, there is no difference in the incidence of bacteremia.

Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia.

To assess whether methicillin resistance is a microbial characteristic associated with deleterious clinical outcome, we performed a cohort study on 908 consecutive episodes of Staphylococcus aureus bacteremia and a case-control study involving 163 pairs of patients matched for preexisting comorbidities, prognosis of the underlying disease, length of hospitalization, and age. Of 908 bacteremic episodes, 225 (24.8%) were due to methicillin-resistant S. aureus (MRSA). Multivariate analysis did not reveal that methicillin resistance was an independent predictor for mortality when shock, source of bacteremia, presence of an ultimately or rapidly fatal underlying disease, acquisition of the infection in an intensive care unit (ICU), inappropriate empirical therapy, female sex, and age were taken into account. Nonetheless, methicillin resistance was an independent predictor for shock. The case-control study could not confirm that shock was linked to MRSA when prior antimicrobial therapy, inappropriate treatment, ICU residence, and female sex were considered. Our data suggest that cohort studies tend to magnify the relationship of MRSA with clinical markers of microbial pathogenicity and that this effect is a shortcoming of these kind of studies that is caused by inadequate control for underlying diseases.

[Predictive factors of the presence of bacteremia in males with urinary infection]. / Factores predictivos de la presencia de bacteriemia en los varones con infección urinaria.

UNLABELLED: BACKGROUND AND PATIENTS AND METHODS: Possible predictive factors of the presence of bacteremia in 135 males with parenchymatous urinary tract infection (PUI) are studied by means of univariate and multivariate analysis. RESULTS: Thirty percent of the patients had bacteremia. In the multivariate analysis the following factors were significative: duration of symptoms > 5 days, a serum creatinine level > 1.2 mg/dl and duration of symptoms > 5 days. CONCLUSIONS: One third of the males with community acquired PUI have bacteremia. The best predictors of the presence of bacteremia are a serum creatinine level > 1.2 mg/dl and duration of symptoms > 5 days.

[Cefixime versus amoxicillin plus netilmicin in the treatment of community-acquired non-complicated acute pyelonephritis]. / Cefixima frente a la asociación de amoxicilina con netilmicina en el tratamiento de la pielonefritis aguda no complicada.

BACKGROUND: Community-acquired non-complicated acute pyelonephritis (APN) is a frequent, occasionally serious infection (around 20% of the cases are bacteremic) that usually requires hospital admission. The third generation oral cephalosporins which are active against more than 95% of E. coli strains should allow the outpatient management of these patients. OBJECTIVE: To evaluate the bacteriological and clinical efficacy of oral cefixime in comparison to amoxicilin plus netilcilin in the treatment of APN. PATIENTS AND METHODS: Patients older than 18 years affected by APN were included in a fourteen month prospective study. According to a random numbers chart, the patients received cefixime (400 mg/24 h in a single daily dose for 12 days) or amoxicilin (1 g/8 h per os) plus netilmicin (4 mg/kg/24 h in a single intramuscular daily dose) during five days followed by 7 days of an oral treatment chosen according to the susceptibility pattern of isolated microorganism. RESULTS: Sixty-one patients received cefixime and 65 amoxicillin plus retilmicin. There were no significant differences between both groups of patients. Thirty-two patients presented bacteremia (25.4%). The mean (SD) eak and trough concentrations of netilmicin were 11.4 (2.8) mg/l and 0.38 (0.4) mg/l, respectively. Clinical response was favorable in 97% of patients treated with cefixime and in 98% of those treated with amoxicilin plus netilmicin (p = NS). The infection recurred in 10 out of 59 patients (16.9%) in the cefixime arm of the study and in 9 out of 64 patients (14%) treated with amoxicillin plus netilmicin (p = NS). Tolerance to the study drugs was good in both arms of the study, and renal function remained normal. CONCLUSION: Cefixime seems to be an acceptable alternative to the regimens containing an aminopenicillin and an aminoglycoside for the treatment of community-acquired non-complicated APN.

[Chronic enteropathy of unknown etiology in patients with AIDS. An analysis of 40 cases]. / Enteropatía crónica de etiología desconocida en pacientes con SIDA. Análisis de 40 casos.

BACKGROUND: Data about the etiology of chronic enteropathy in AIDS patients are scarce and are very dependent upon the geographical area. The aim of this study was to detect microorganisms potentially associated with chronic enteropathy in AIDS patients with diarrhoea for more than one month, and initial negative routine stool bacterial cultures and examinations for ova and parasites. The degrees of associated intestinal malabsorption and immunodeficiency were also analysed. PATIENTS AND METHODS: Forty consecutive patients were recruited from January 1993 to December 1994. The following studies were performed: Intestinal absorption tests (d-xylose and 14C-triolein), CD4/CD8 cell counts, microbiological studies (standard stool cultures for detection of bacteria and examinations for ova and parasites including the detection of Enterocitozoon bieneusi spores by the Weber's stain), upper gastrointestinal endoscopy or colonoscopy with intestinal biopsies and blood cultures for CMV and mycobacteria. RESULTS: The median duration of diarrhoea was 4 months and the mean weight loss was 8.4 kg. Ninety percent of patients had less than 0.1 x 10(9) CD4+ cells/l, with a mean CD4+ cell count of 0.035 x 10(9)/l. Malabsorption was found in 84% of patients. An etiological diagnosis of chronic enteropathy was reached in 60% of the patients. The yield of pathological examination was 37% and the microbiological test using samples of faeces and blood were positive in 45% and 20% of cases respectively. The most frequently identified microorganisms were CMV (10 cases), E. bieneusi (9), enterobacteria (8), Cryptosporidium parvum (5), Leishmania donovani (2). Patients with enteropathy caused by E. bieneusi had lower count of CD4 cells (p = 0.005) and with higher serum levels of alkaline phosphatase (p = 0.02) than patients with CMV enteropathy. CONCLUSIONS: Stool Weber's stain and CMV and mycobacterial blood cultures should be added to the standard work-up diagnosis in patients with chronic diarrhoea and a CD4+cells count below 0.1 x 10(9) l. Upper and/or lower gastrointestinal endoscopies with intestinal biopsies should be performed only in patients with persistent diarrhea without microbiological diagnosis or a lack of response to treatment.

[Intestinal microsporidiosis in patients with AIDS: study of 3 cases]. / Microsporidiosis intestinal en enfermos con sida: estudio de tres casos.

Enterocytozoon bieneusi is a protozoa belonging to the Microsporidia family which prevalence has increased in AIDS patients. Although diagnosis is performed by the demonstration of the parasite in the epithelium of the small intestine by light and electron microscopy, techniques allowing diagnosis from stools or duodenal or biliary aspirates have recently been described. Three cases of intestinal microsporidiosis diagnosed by the mentioned method are reported. The patients were 3 males with chronic diarrhea of several months of evolution with an important ponderal loss. All were in advanced stages of HIV infection with CD4-lymphocyte counts lower than 0.1 x 10(9)/l. In all the patients in whom intestinal absorption tests were performed these were found to be altered. One of the patients presented concommitant cholestasis with parasitation by E. bieneusi being demonstrated as by the biliary route in this patient. Confirmation of infection by E. bieneusi was performed in the 3 cases by electron microscopy study of stools. A review of intestinal microsporidiosis in AIDS patients is carried out and the therapeutic possibilities available for this infection are discussed.