Malestar e ictericia. Hepatitis tóxica por Copalchi / Illness and jaundice. Copalchi toxic hepatitis

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Dolor inguinal agudo no traumático en urgencias: artritis coxofemoral en paciente joven / Non-traumatic acute groin pain in emergency departments: hip arthritis in a young patient

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Evaluación de la eficacia de un protocolo destinado a mejorar el control glucémico de los pacientes con hiperglucemia ingresados en servicios hospitalarios de medicina interna / Evaluation of the effectiveness of a protocol designed to improve glycemic control in hospitalized internal medicine patients with hyperglycemia

Objetivos: Los objetivos del presente trabajo fueron evaluar si la difusión de un protocolo de manejo de la hiperglucemia sería capaz de incrementar el uso de insulina programada y mejorar el control glucémico durante la estancia hospitalaria. Pacientes y métodos: Estudio observacional de cohortes retrospectivo analítico. Se comparan 2 grupos de pacientes dados de alta con un diagnóstico relacionado con diabetes (DM) en servicios de Medicina Interna, antes (grupoPRE) y después (grupoPOS) de la implantación de un protocolo de actuación. Las respuestas analizadas fueron indicadores de proceso (probabilidad de permanecer sin insulina programada, evaluada mediante curvas de Kaplan-Meier), y de resultados (diferencias ajustadas (grupoPOS - grupoPRE) de control glucémico, evaluadas mediante regresión lineal múltiple). Resultados: Hubo 228 pacientes en el grupoPRE y 127 en el grupoPOS. La mediana del tiempo hasta el inicio de insulina programada fue de un día (IC 95%: 0-2,5) en el grupoPOS y de cuatro días (IC 95%: 2-6) en el grupoPRE (p=0,056). La glucemia en las primeras 48 horas de ingreso entre los pacientes que no recibieron insulina programada fue inferior en el grupoPOS respecto al grupoPRE (163,9 vs 186,7 mg/dl; p=0,025). La glucemia media las primeras 24 horas fue inferior en el grupoPOS (diferencia: -24,8 mg/dl (IC 95%: -40,5-(-9); p=0,002)). En análisis estratificado, la diferencia en glucemia media durante el ingreso fue significativa en los pacientes en ayunas (-29,8 mg/dl; IC 95%: -58,9-(-0,6); p=0,045) pero no en aquellos con ingesta conservada. Conclusión: Un protocolo específico puede mejorar la calidad en la asistencia hospitalaria al paciente con DM (AU)

Background: Our aims were to assess the effectiveness of a diabetes (DM) management protocol to increase scheduled insulin therapy and to improve glycemic inpatient control. Patients and methods: We designed an analytical retrospective cohort study comparing 2 groups of medical services hospitalized patients with a primary or secondary discharge diagnosis of DM, before (group PRE) and after (group POS) the delivery of a DM management protocol. We analyzed the quality of attention by process indicators (cumulative probability of receive scheduled insulin therapy, evaluated with Kaplan-Meier analysis) and result indicators (adjusted glucose differences (group POS - group PRE), evaluated with multivariate regression models). Results: A number of patients (355) were included (228 group PRE and 127 group POS). The median time to scheduled insulin regimen beginning was 1 (CI 95%: 0-2.5) day in group POS and 4 (CI 95%: 2-6) days in group PRE (p=0.056). First 48 hours mean glucose in patients without scheduled insulin therapy was lower in group POS than in group PRE (163.9 versus 186.7 mg/dl; p=0.025). The first 24 hours mean glucose was significantly lower in patients of group POS, with a difference between both groups of -24.8 mg/dl (CI 95%: -40.5-(-9); p=0.002). Stratified analysis showed statistically significant mean in-hospital glucose difference only in the nothing by mouth situation (-29.8 mg/dl; CI 95%: -58.9-(-0.6); p=0.045). Conclusion: The delivery of an institutional protocol can improve hospitalized DM patients management quality (AU)

[Evaluation of the effectiveness of a protocol designed to improve glycemic control in hospitalized internal medicine patients with hyperglycemia]. / Evaluación de la eficacia de un protocolo destinado a mejorar el control glucémico de los pacientes con hiperglucemia ingresados en servicios Hospitalarios.

BACKGROUND: Our aims were to assess the effectiveness of a diabetes (DM) management protocol to increase scheduled insulin therapy and to improve glycemic inpatient control. PATIENTS AND METHODS: We designed an analytical retrospective cohort study comparing 2 groups of medical services hospitalized patients with a primary of secondary discharge diagnosis of DM, before (group PRE) and after (group POS) the delivery of a DM management protocol. We analyzed the quality of attention by process indicators (cumulative probability of receive scheduled insulin therapy, evaluated with Kaplan-Meier analysis) and result indicators (adjusted glucose differences (group POS - group PRE), evaluated with multivariate regression models). RESULTS: A number of patients (355) were included (228 group PRE and 127 group POS). The median time to scheduled insulin regimen beginning was 1 (CI 95%: 0-2.5) day in group POS and 4 (CI 95%: 2-6) days in group PRE (p=0.056). First 48 hours mean glucose in patients without scheduled insulin therapy was lower in group POS than in group PRE (163.9 versus 186.7 mg/dl; p=0.025). The first 24 hours mean glucose was significantly lower in patients of group POS, with a difference between both groups of -24.8 mg/dl (CI 95%: -40.5-(-9); p=0.002). Stratified analysis showed statistically significant mean in-hospital glucose difference only in the nothing by mouth situation (-29.8 mg/dl; CI 95%: -58.9-(-0.6); p=0.045). CONCLUSION: The delivery of an institutional protocol can improve hospitalized DM patients management quality.

[Nephritic colic management in an emergency room of a referral hospital]. / Manejo del cólico renal en urgencias de un hospital de tercer nivel.

BACKGROUND: To evaluate the diagnostic and therapeutic management of patients with nephritic colic in a referral hospital, their monitoring and the incidence of alternative diagnoses. METHODS: This is a retrospective review of 182 randomly selected patients who presented a clinical diagnosis compatible with nephritic colic in a referral hospital. In these cases initial treatment, monitoring and alternative diagnoses have been evaluated. RESULTS: Fifty-five point four percent of the patients were male, the mean age was 47.7 years and 40% of the cases were in spring. Urinalysis was carried out in every patient (62.7% dipstick and 72% urinary sediment); they were pathological in over 70%. In 26.4% of cases renal function deteriorated, always transiently. Abdominal radiography (81.9%) was the most frequently diagnostic test performed, followed by ultrasound (25.8%). Treatment included a serum therapy in 31.3%; metamizol (61%) was the most commonly used analgesic followed by ketorolac (44.5%). More than one non-steroidal anti-inflammatory was used by 46.2%. Hospital admission was required by 24 patients, and 5 of them needed emergency surgery. Twenty-four point one percent of patients had relapses during the next six months. Forty-one point six percent were referred to urology discharge on from the emergency room. Eighteen point one percent of patients had alternative diagnoses; acute pyelonephritis was the most frequent of these (55%). CONCLUSIONS: In our work we found a significant variation in the diagnostic and therapeutic management of these patients. The use of clinical guidelines could help us to unify the management of patients with nephritic colic, both in the emergency room and on discharge. Due to the high prevalence of alternative diagnoses, we have to systematically exclude more serious diseases.

Manejo del cólico renal en urgencias de un hospital de tercer nivel / Nephritic colic management in an emergency room of a referral hospital

Fundamento. El objetivo del presente trabajo es conocerlas características epidemiológicas, el manejo diagnóstico yterapéutico, su seguimiento y la incidencia de diagnósticosalternativos en una muestra de pacientes diagnosticados decólico renal en el Servicio de Urgencias de un Hospital detercer nivel.Material y métodos. Estudio descriptivo retrospectivo de182 pacientes seleccionados aleatoriamente que consultanpor clínica compatible con cólico renal en un hospital detercer nivel, valorando su manejo inicial, seguimiento al altay diagnósticos alternativos.Resultados. El 55,4% fueron varones, la edad media fue de47,7 años y el 40% de los casos se produjeron en primavera.En todos los pacientes se realizó analítica urinaria (62,7%tira reactiva y 72% sedimento) apareciendo alteraciones enmás del 70%. La función renal se deterioró en el 26,4 % delos casos, siempre de forma transitoria. La prueba de imagenrealizada con más frecuencia fue la radiografía de abdomen(81,9%) seguida de la ecografía (25,8%). El tratamiento incluyófluidoterapia en el 31,3% y el analgésico más usado fue elmetamizol (61%) seguido del ketorolaco (44,5%). El 46,2% delos pacientes necesitó más de un analgésico. Un total de 24pacientes precisaron ingreso hospitalario y 5 de ellos cirugíaurgente. El 24,1% presentó recaídas en los seis meses posteriores.El 41,6% fue remitido al Servicio de Urología al alta. El18,1% presentaron diagnósticos alternativos, siendo la pielonefritisaguda el más frecuente de ellos (55%).Conclusiones. Hemos detectado una importante variaciónen el manejo diagnóstico y terapéutico de estos pacientes.El uso de guías clínicas debe permitirnos unificar el manejodel paciente con cólico renal tanto en urgencias como posteriormente.El alto porcentaje de diagnósticos alternativosnos obliga a descartar sistemáticamente patologías másgraves(AU)

Background. To evaluate the diagnostic and therapeuticmanagement of patients with nephritic colic in a referralhospital, their monitoring and the incidence of alternativediagnoses.Methods. This is a retrospective review of 182 randomly selectedpatients who presented a clinical diagnosis compatiblewith nephritic colic in a referral hospital. In these casesinitial treatment, monitoring and alternative diagnoses havebeen evaluated.Results. Fifty-five point four percent of the patients weremale, the mean age was 47.7 years and 40% of the cases werein spring. Urinalysis was carried out in every patient (62.7%dipstick and 72% urinary sediment); they were pathologicalin over 70%. In 26.4% of cases renal function deteriorated,always transiently. Abdominal radiography (81.9%) was themost frequently diagnostic test performed, followed by ultrasound(25.8%). Treatment included a serum therapy in 31.3%;metamizol (61%) was the most commonly used analgesic followedby ketorolac (44.5%). More than one non-steroidal anti-inflammatory was used by 46.2%. Hospital admission wasrequired by 24 patients, and 5 of them needed emergencysurgery. Twenty-four point one percent of patients had relapsesduring the next six months. Forty-one point six percentwere referred to urology discharge on from the emergencyroom. Eighteen point one percent of patients had alternativediagnoses; acute pyelonephritis was the most frequent ofthese (55%).Conclusions. In our work we found a significant variationin the diagnostic and therapeutic management of these patients.The use of clinical guidelines could help us to unifythe management of patients with nephritic colic, both in theemergency room and on discharge. Due to the high prevalenceof alternative diagnoses, we have to systematicallyexclude more serious diseases(AU)

Choriocarcinoma with pulmonary and cerebral metastases.

Choriocarcinoma is an aggressive tumour. Uncommonly, it spreads distantly, and rarely results in pulmonary and brain metastases. Its prognosis is generally good when treated. We report a 33-year-old woman with fever, haemoptysis and asthenia. One month after the appearance of metrorrhagia, she was diagnosed to have choriocarcinoma with pulmonary metastasis. After chemotherapy, pulmonary images disappeared and human chorionic gonadotropin returned to normal. She was re-admitted with neurological signs ten months later, confirming recurrence of the disease with brain metastasis. She was treated with surgery and polychemotherapy, with a favourable outcome and disappearance of the disease.

Signo del tres invertido y pirosis / No disponible

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[Generalized tonic-clonic seizure in immigrant]. / Crisis generalizada tonicoclónica en inmigrante.

INTRODUCTION: Neurocysticercosis is a disease caused by infection of the central nervous system by the larva of Taenia solium whose main clinical manifestation is epileptic seizures. This disease, whose prevalence had decreased in Spain in previous decades, has been increasing in importance due to the increased migratory flows from endemic zones and international trips. A recent clinical case is presented to review the diagnostic criteria of this condition. CLINICAL CASE: 47 year old woman, native of Ecuador, with disease backgrounds of high blood pressure, who was admitted due to generalized tonic-clonic episodes. The neurological examination was consistent with normality. In the computed tomography (CT) scan images, several cystic lesions with scolex inside were observed. Positive results were obtained in the serology for Taenia solium in the cerebrospinal fluid. The CT scan lesion resolution was complete after completing cysticide treatment with albendazole. CONCLUSIONS: Neurocysticercosis should be considered as a diagnosis in all adult patients with epileptic seizures who have the epidemiological characteristics indicated.

Crisis generalizada tonicoclónica en inmigrante / Generalized tonic-clonic seizure in inmigrant

Introducción. La neurocisticercosis es una patología producida por la infestación del sistema nervioso central por las formas larvarias de la Taenia solium, cuya principal manifestación clínica son las crisis epilépticas. Esta patología, cuya prevalencia había disminuido en España en las décadas previas, va incrementando su importancia debido al aumento de los flujos migratorios desde zonas endémicas y los viajes internacionales. Se presenta un caso clínico reciente para revisar los criterios diagnósticos de este proceso. Caso clínico. Paciente mujer de 47 años, natural de Ecuador, con antecedentes patológicos de hipertensión arterial, que ingresa por crisis tonicoclónica generalizada. La exploración neurológica fue compatible con la normalidad. En las imágenes de la tomografía computarizada (TC) se objetivaron varias lesiones quísticas con escólex en su interior. Se obtuvieron resultados positivos en la serología para Taenia solium en el líquido cefalorraquídeo. La resolución de las lesiones de la TC fue completa tras completar tratamiento cisticida con albendazol. Conclusiones. La neurocisticercosis debe plantearse como diagnóstico en todo paciente adulto con crisis epilépticas que presente las características epidemiológicas indicadas

Introduction. Neurocysticercosis is a disease caused by infection of the central nervous system by the larva of Taenia solium whose main clinical manifestation is epileptic seizures. This disease, whose prevalence had decreased in Spain in previous decades, has been increasing in importance due to the increased migratory flows from endemic zones and international trips. A recent clinical case is presented to review the diagnostic criteria of this condition. Clinical case. 47 year old woman, native of Ecuador, with disease backgrounds of high blood pressure, who was admitted due to generalized tonic-clonic episodes. The neurological examination was consistent with normality. In the computed tomography (CT) scan images, several cystic lesions with scolex inside were observed. Positive results were obtained in the serology for Taenia solium in the cerebrospinal fluid. The CT scan lesion resolution was complete after completing cysticide treatment with albendazole. Conclusions. Neurocysticercosis should be considered as a diagnosis in all adult patients with epileptic seizures who have the epidemiological characteristics indicated