Perfil del usuario de un servicio de urgencias hospitalarias. Hiperfrecuentación / Characteristics of hospital emergency departments users. Frequent users

Objetivo: Describir la población que acude a Urgencias hospitalarias e identificar las causas de dichas visitas, así como describir el perfil de los que las visitan de forma repetitiva. Método: Estudio descriptivo de visitas y personas que acudieron en 2013. Se han clasificado como infrecuentes si realizaron de una a 3 visitas al año, frecuentes si realizaron de 4 a 9, e hiperfrecuentadores 10 o más. Resultados: En 2013 hubo 86.673 visitas. Se produjeron más visitas en verano y diciembre, y con más visitas en martes, lunes y domingo. El diagnóstico más frecuente fue «lesiones y envenenamientos» (24,3%) y el segundo fue «síntomas, signos y estados mal definidos» (17,1%). En la mayoría de las visitas el destino al alta fue el domicilio (90,6%). En 2013 visitaron urgencias 51.672 personas (50,8% mujeres y 10,2% menores de 15 años). Las personas entre 31 y 50 años y los mayores de 65 años acudieron frecuentemente. Las tasas de frecuentación eran mayores en las personas de zonas cercanas al hospital. Un total de 237 personas (0,5%) realizaron 10 o más visitas en el año. De ellas, 81 acudieron por causas no justificadas. Conclusiones: Las visitas debidas a «estados mal definidos» no son despreciables, sería interesante profundizar en estas causas para establecer medidas. La distancia parece determinante a la hora de acudir al hospital. No se observa relación entre el nivel socioeconómico y frecuentación. La hiperfrecuentación aumentó con la edad y con patología crónica asociada, aunque los hiperfrecuentadores con visitas no justificadas eran más jóvenes

Objective: To present an assessment of the different profiles of patients that visit the emergency department, including a description of the illness leading to such visits, as well to describe the profiles of individuals who visit with high frequency. Method: The study was carried out during 2013. Users were classified as infrequent if they made 1 to 3 visits per year, frequent if they made 4 to 9, and hyper-frequent if they visited at least 10 times. Results: There were 86,673 visits in 2013. There were more visits in July, August and December. Tuesday, followed by Monday and Sunday, were the days that had the highest frequency of visits. The most frequent diagnosis at discharge was "injuries and poisonings" (24.3%), followed by "poorly defined signs, symptoms and status (17.1%) of the visits corresponded to poorly defined states. The discharge to home rate was 90.6%. Out of the 51,672 people who visited the hospital in 2013, 50.8% were female, and 10.2% were under 15 years. Those patients between The ages of 31 and 50, and those over 65 had the highest frequency rate. People living closer to the hospital had higher frequency rate .There were 237 people (0.5%) who made at least 10 visits, and among those, 81 people for no justifiable reason. Conclusions: An in-depth analysis of the visits due to "poorly defined signs, symptoms and status" would be interesting. The distance to the hospital seems to be determining factor for frequent visits. There is no relationship between socioeconomic status and the number of visits. The frequency of visits increases with age and associated chronic disease, although the high-frequency users with unjustified visits were younger

[Characteristics of hospital emergency departments users. Frequent users]. / Perfil del usuario de un servicio de urgencias hospitalarias. Hiperfrecuentación.

OBJECTIVE: To present an assessment of the different profiles of patients that visit the emergency department, including a description of the illness leading to such visits, as well to describe the profiles of individuals who visit with high frequency. METHOD: The study was carried out during 2013. Users were classified as infrequent if they made 1 to 3 visits per year, frequent if they made 4 to 9, and hyper-frequent if they visited at least 10 times. RESULTS: There were 86,673 visits in 2013. There were more visits in July, August and December. Tuesday, followed by Monday and Sunday, were the days that had the highest frequency of visits. The most frequent diagnosis at discharge was "injuries and poisonings" (24.3%), followed by "poorly defined signs, symptoms and status (17.1%) of the visits corresponded to poorly defined states. The discharge to home rate was 90.6%. Out of the 51,672 people who visited the hospital in 2013, 50.8% were female, and 10.2% were under 15 years. Those patients between The ages of 31 and 50, and those over 65 had the highest frequency rate. People living closer to the hospital had higher frequency rate .There were 237 people (0.5%) who made at least 10 visits, and among those, 81 people for no justifiable reason. CONCLUSIONS: An in-depth analysis of the visits due to "poorly defined signs, symptoms and status" would be interesting. The distance to the hospital seems to be determining factor for frequent visits. There is no relationship between socioeconomic status and the number of visits. The frequency of visits increases with age and associated chronic disease, although the high-frequency users with unjustified visits were younger.

[Heat and vestibular stimulation]. / Calor y estimulación vestibular.

In 1905 Barany analyzed the nystagmus that appears during the irrigation of the ear with cold and hot water, justifying the phenomenon due to convectives currents in the horizontal semicircular canal. This hypothesis has been widely accepted until doubt was casted on it by the experiences carried out in the Skylab. Of the various mechanisms that could be responsible for the vestibular stimulation in the caloric tests, those which entail convection currents or endolymph expansion would need--we think--thermal gradients very superior to those occurring during these tests, that according to our calculations--always pro such hypothesis--seem insufficient.

Plasminogen activator inhibitor activity in bacterial infection.

It has been experimentally shown that endotoxin induces a marked increase in the levels of a fast-acting inhibitor of plasminogen activator (PAI). The plasma PAI activity and tissue-type plasminogen activator (t-PA) concentrations were measured in 61 patients with human septicaemia and results were compared with those observed in healthy controls. There was a markedly significant increase of PAI in plasma and platelet extracts of patients with septicaemia as compared to controls (p less than 0.0001). No correlation between PAI and endotoxin concentration was observed. Fibrin autography of plasma samples confirmed that activator inhibition was associated with the formation of an enzyme-inhibitor complex. t-PA activity was similar in patients and controls, whereas t-PA Ag showed a significant increase in patients (p less than 0.0001). A significant inverse correlation between t-PA activity and PAI was observed (p less than 0.05). PAI activity was higher in patients with positive blood cultures (p less than 0.0001) and gram-negative septicaemia (p less than 0.0001). There was also a significant increase of PAI levels in patients with disseminated intravascular coagulation (DIC) as compared with patients without DIC (p less than 0.001). We conclude that there is a marked increase of PAI in patients with sepsis. Increased PAI activity may contribute to the pathogenesis of DIC associated with septicaemia.

Absceso subfrénico. Revisión estadística de esta complicación / Subphrenic abscess. A statistical review of this complication

Se revisan 20 expedientes clínicos de pacientes que presentan abscesos subfrénicos como complicación de enfermedad de base prexistente, en el período comprendido entre enero de 1974 y diciembre de 1978, en el hospital clinicoquirúrgico docente "General Calixto García". Se realizan múltiples variables de interés y se comparan con la literatura mundial revisada. Se exponen las conclusiones(AU)

Trabajo preliminar de diversos tipos de suturas colónicas en colon sin preparación, realizadas en perros / A preliminary report of differnt types of colonic suture for non-prepared colon in dogs

Se realiza un estudio preliminar de carácter investigativo, con 18 animales de experimentación (perros), a los cuales se les dividió en 6 grupos al azar, asignando 3 perros a cada grupo; a cada uno de ellos se les realizó una resección colónica, en colon sin preparación previa, y anastomosis con distintos tipos y métodos de sutura; se exponen los resultados obtenidos, incluyendo en éstos diversas variables posoperatorias de cada grupo de animales por separado. Se revisa la literatura médica mundial. Se realizan conclusiones(AU)