Mortalidad hospitalaria por intoxicación aguda en España (EXITOX 2012) / Hospital mortality due to acute poisoning: EXITOX 2012

Los registros de mortalidad son un instrumento para la planificación de las actuaciones en el ámbito de la salud pública. A pesar de ello, los datos sobre fallecimientos por intoxicación aguda en España son escasos. Se presenta un estudio descriptivo, de encuesta transversal, de pacientes fallecidos en el año 2012 como consecuencia de una intoxicación aguda en 8 hospitales públicos españoles, incluidos en el registro EXITOX. Se registraron 14 casos, con una edad media de 59,1 años, 71% varones y de causa suicida en el 50%. Los cáusticos fueron el principal grupo de tóxicos implicado(35,7%), seguido de los fármacos (21,4%) y las drogas de abuso (21,4%). La tasa de mortalidad por intoxicación fue de 0,5 casos/100.000 habitantes. Se utilizaron medidas terapéuticas toxicológicas específicas en el 28,6%. Se consideró como indudable la relación entre intoxicación y fallecimiento en el 71%. Aún con las limitaciones existentes, el registro EXITOX parece ser una herramienta adecuada para conocer la mortalidad por intoxicación aguda en España (AU)

Death registers are a tool for planning public health care interventions, but data on deaths due to acute poisoning are scarce in Spain. We report a descriptive study based on a cross-section of patients who died from acute poisoning in2012 in 8 Spanish public hospitals and whose deaths were recorded in the EXITOX register. Of the 14 registered cases, 7(50%) were suicides; 71% were men, and the mean age was 59.1 years. Caustic substances comprised the largest category (35.7%) of toxic agents, followed by medications (21.4%), and street drugs (21.4%). The mortality rate was0.5 deaths/100 000 inhabitants. Specific antidotes were used in 28.6% of the cases. In 71%, there was a clear relationship between death and acute poisoning. The EXITOX register, even with its limitations, seems to provide an appropriate tool for understanding mortality due to acute intoxication in Spain (AU)

Alargamiento del intervalo QTc en pacientes cons íntomas relacionados con el consumo de cocaína / QTc prolongation in patients with symptoms of cocaine use

Objetivo: Determinar si el consumo de cocaína produce alargamiento del intervalo QTc y sise correlaciona con los niveles de benzoilecgonina. Método: Estudio de los pacientes que consultaron en urgencias por síntomas relacionados con el consumo de cocaína durante el año 2009. Se recogió edad, sexo y consumo de fármacos potencialmente alargadores del intervalo QT. Se consideró alargado un QTc superiora 450 msg. Se realizaron niveles cuantitativos de benzoilecgonina. Se utilizó un grupo control de no consumidores de cocaína y se determinaron las diferencias entre los dos grupos. Resultados: Se recogieron 44 casos y 18 controles. El QTc estaba más alargado en los consumidores (445,7 vs 411,1 mseg; p < 0,001). El porcentaje de QTc patológicamente alargados fue superior en los consumidores (59,1% vs 16,7%; p = 0,002). No se encontró correlación entre los niveles de benzoilecgonina y la duración del QTc. Nueve pacientes estaban en tratamiento con fármacos con posibilidad de alterar el QT. No se encontraron diferencias entre el QTc de estos casos y el de los que no tomaban dichos fármacos, así como tampoco en el porcentaje de QTc patológicos. Conclusiones: El consumo de cocaína produce alargamiento del QTc, así como mayor porcentaje de QTc patológicamente largos. Estas diferencias no se ven influenciadas por la toma de fármacos alargadores del QT. No se ha encontrado correlación entre los niveles debenzoilecgonina y la duración del QT (AU)

Objetive: To assess the presence of QTc prolongation in emergency department patients with symptoms of cocaine intoxication and to determine whether QTc prolongation correlated with benzoylecgonine level. Methods: The records of all patients coming to the emergency department with symptoms of cocaine intoxication in2009 were reviewed to collect data on age, sex, and use of drugs that could cause QTc prolongation A QTc intervallonger than 450 milliseconds was considered prolonged. Benzoylecgonine levels were also recorded. A group of nonusers of cocaine were used as controls. Results: Data for 44 cases and 18 controls were included. The QTc interval was prolonged in cocaine users (445.7milliseconds vs 411.1 milliseconds in nonusers; P<.001). A higher percentage of cases had QTc prolongation (59.1% vs16.7% of the controls; P=.002). Benzoylecgonine level and QTc duration were not correlated. Nine patients were in treatment with drugs that could cause QT interval changes. However, QTc duration did not differ between these patients and others who were not taking those drugs; nor were the percentages of QTc interval disturbances different between these 2 patient groups. Conclusions: Cocaine use causes QTc prolongation and is associated with more observations of pathologically prolonged intervals. The differences are not influenced by medications that also prolong the QT interval. Benzoylecgonine level and QTc duration are not correlated (AU)

Drogas emergentes (I): las «smart drugs» / Emergent drugs (I): smart drugs

En los últimos años han ganado popularidad unaserie de nuevas drogas, conocidas como smart drugs olegal highs, fácilmente accesibles a través de tiendas online.Ello ocurre sobre todo en los segmentos jóvenesde la población, asociado a su consumo lúdico fundamentalmentedurante los fines de semana.En general son derivados sintéticos de productosnaturales, de los que apenas existe investigación clínicay que no son detectables en los laboratorios de loshospitales.Tres de estos productos, el BZP (1-benzilpiperacina),la mefedrona (4-metilcatinona) y el Spice sonprobablemente los más utilizados en Europa. Los dosprimeros se consumen como alternativas al éxtasis y lacocaína, y se caracterizan por producir un cuadro clínicode tipo simpaticomimético, en ocasiones de consecuenciasgraves, con convulsiones e incluso muerte. ElSpice (mezcla de hierbas con cannabinoides sintéticoscomo el JWH-018, el JWH-073 y el CP 47,497-C8) estáocasionando cuadros de dependencia y esquizofrenia.Aunque las drogas emergentes poseen un aurade seguridad, cada vez hay más experiencia sobre susefectos secundarios(AU)

In recent years, a series of new drugs, known assmart drugs or legal highs, have gaining in popularity.They are easily obtainable through online shops. Thisis happening amongst younger segments of the populationand is associated with recreational consumption,at weekends.In general, they are synthetic derivatives of naturalproducts. There has been hardly any clinical researchinto them and they are not detectable in hospital laboratories.Three of these products, BZP (1-benzylpiperazine),mefedrone (4-methylmethcathinone) and Spice are probablythe most widely used in Europe. The first two areconsumed as an alternative to ecstasy and cocaine andare characterized by their producing a clinical profile ofa sympathetic mimetic type; on occasion, they have seriousconsequences, with convulsions and even death.Spice (a mixture of herbs with synthetic cannabinoidssuch as JWH-018, JWH-073 and CP 47497-C8) is givingrise to profiles of dependence and schizophrenia.Although the emergent drugs have an aura of safety,there is an increasing amount of experience on theirsecondary effects(AU)

[Informed consent: opinions of health care personnel from a teaching hospital]. / Consentimiento informado: opiniones del personal sanitario de un hospital universitario.

OBJECTIVE: To conduct a descriptive analysis of the opinions of health care personnel regarding different aspects related with the informed consent, and mainly the information given on informed consent forms. MATERIAL AND METHODS: All health care professionals (physicians, nurses and nursing auxiliaries) of a teaching hospital were invited to fill out an anonymous, 20-item questionnaire based on legal health guidelines. Degree of knowledge was assessed by age, professional and seniority status, speciality or position and bioethical background. RESULTS: The questionnaire was filled out by 277 participants, with a hospital participation of 67%. A total of 45.1% of the health care professionals believed they had insufficient information on what the informed consent consists of and when it should be completed by patients; 81.2% considered that informed consent is an instrument of professional protection against demands by the user; 62.8% thought that the information provided is not sufficiently clear to the patient; 76.2% that the reading and understanding are difficult for the average person and 37.9% considered that there is excessive information. Regarding the basic elements that should be included in the informed consent form, 96.7% advocate information, 93.5% comprehension, 84.1% willingness and 74% competence. A total of 98.9% of participants believed that side effects of a diagnostic or therapeutic intervention should be specified in the document, 57% the likelihood of success and 70.8% alternatives. Furthermore, 59.6% are not in favor of using numerical percentages to express procedure risks. CONCLUSIONS: Half of health-care professionals were unaware of what an informed consent consists of, its different sections, the law that regulates it and the philosophy underlying its development.

Piroxicam fast-dissolving dosage form vs diclofenac sodium in the treatment of acute renal colic: a double-blind controlled trial.

OBJECTIVE: To assess the possible therapeutic effect of 40 mg sublingual piroxicam (fast-dissolving dosage form, FDDF) compared with intramuscular 75 mg diclofenac, as a reference drug, on acute renal colic in a randomized, double-blind controlled clinical trial. PATIENTS AND METHODS: Eighty patients were assigned to one of two treatment groups; one received an intramuscular injection with 0.2 mL distilled water and two sublingual tablets of 20 mg piroxicam FDDF, and the other received an intramuscular injection with 75 mg diclofenac sodium and two sublingual tablets of placebo. Pain intensity was evaluated by the patient using a visual analogue scale and by the observers. Vital signs at baseline and 30 min after the administration of the study drugs were also recorded. RESULTS: The overall efficacy of the treatment was 81%; nine patients in the piroxicam and six in the diclofenac group (no significant difference) required rescue treatment. Compared with baseline levels, the pain relief was significant (P < 0.001) at 30 min in both groups. Twenty-two patients in the piroxicam and 25 in the diclofenac group attained complete pain relief at 30 min, as evaluated by the observer (no significant difference). Both treatments were similarly effective in decreasing vital signs, mainly systolic blood pressure, heart and respiratory rates. However, when the percentage change was compared between the groups, piroxicam significantly decreased the respiratory rate (P < 0.03). CONCLUSION: Piroxicam FDDF is as effective as parenteral diclofenac in emergency renal colic treatment. Furthermore, its ease of self-administration increases patient compliance and potential use in general practice.