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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 26-32, feb. 2020. tab
Artigo em Espanhol | LILACS-Express | ID: ibc-ET2-3433

RESUMO

Objetivo: Investigar si existen diferencias clínicas y toxicológicas en pacientes intoxicados por anfetamina (ANF) y metanfetamina (MANF) atendidos en servicios de urgencias. Método: Estudio observacional retrospectivo de intoxicaciones por ANF y MANF con confirmación analítica en Baleares (2013-2018). Se compararon variables clínicas, toxicológicas y de manejo clínico entre grupos. Resultados: 1) Se incluyeron 120 pacientes, 86 (71,7%) grupo ANF y 34 (28,3%) grupo MANF. 2) La confirmación de derivados anfetamínicos se realizó por cromatografía de gases-espectrometría de masas en 787 muestras de orina previamente positivas mediante un método de cribado cualitativo. Se confirmaron 154 (19,6%) muestras. De ellas, 34 fueron excluidas. 3) Se encontraron diferencias significativas entre ANF y MANF en: edad (32,3 vs 28,4 años); sexo (72,1 vs 94,1% hombres); nacionalidad española (64,0 vs 29,4%); en motivos de admisión: alteración de conducta (15,1 vs 0%) y palpitaciones (1,2 vs 20,6%); y en características clínicas: agitación (27,9 vs 8,8%). No hubo diferencias de manejo clínico. El 76,6% de casos fueron polintoxicaciones, más comunes en ANF (82,6 vs 61,8%). En estos casos se detectó principalmente cocaína (63,0%), cannabis (48,9%), MDMA (38,0%) y alcohol (35,9%). La mayor asociación del cannabis con el grupo de ANF fue estadísticamente significativa (45,3 vs 17,6%). La causa de los falsos positivos se identificó en el 78,7% de muestras, siendo el MDMA (71,2%) la principal. Conclusiones: Se observaron diferencias entre ANF y MANF en cuanto a variables demográficas y motivo de asistencia; no obstante en esta serie hubo un alto porcentaje de polintoxicaciones


Objective: To determine whether clinical and toxicologic findings differed between cases of amphetamine (AMP) and methamphetamine (mAMP) poisoning attended in 2 Balearic Island hospital emergency departments. Methods: Retrospective observational study of AMP and mAMP cases with laboratory confirmation between 2013 and 2018. We compared clinical and toxicologic variables as well as clinical management between groups. Results: 1) A total of 120 cases were found: 86 (71.7%) with AMP poisoning and 34 (28.3%) with mAMP poisoning. 2) Drug poisoning was confirmed by gas chromatography associated with mass spectrometry (GC–MS) in 787 urine samples found to be positive during screening. One hundred fifty-four (19.6%) were confirmed by GC–MS. Thirtyfour of them did not meet the inclusion criteria. 3) Significant differences between AMP and mAMP cases were found for age (32.3 vs 28.4 y, respectively); sex (72.1% vs 94.1% men); and Spanish nationality (64.0% vs 29.4%). Reasons for admission and clinical features also differed: the reasons were aberrant behavior (15.1% in the AMP group vs 0% in the mAMP group) and palpitations (1.2% vs 20.6%); agitation was observed in 27.9% and 8.8%, respectively. Clinical management was similar in the 2 groups. Multiple drug poisoning was detected in 76.6% patients and was more common in patients in the AMP group (82.6% vs 61.8%). The additional drugs in these cases were mainly cocaine (63.0%), cannabis (48.9%), 3,4-methylenedioxy-N-methamphetamine (MDMA) (38.0%), and alcohol (35.9%). Cannabis was detected in a significantly higher proportion in the AMP group (45.3%) than in the mAMP group (17.6%). False positives were found in 78.7% of the samples. The culprit drug was most often MDMA (71.2%). Conclusions: AMP poisonings were associated with age over 30 years, Spanish nationality, aberrant behavior, agitation, multiple drug findings, and the use of cannabis. Poisonings caused by mAMP abuse were associated with age under 30 years, non-Spanish nationality, palpitations, and single-drug use

2.
Emergencias ; 32(1): 26-32, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909909

RESUMO

OBJECTIVES: To determine whether clinical and toxicologic findings differed between cases of amphetamine (AMP) and methamphetamine (mAMP) poisoning attended in 2 Balearic Island hospital emergency departments. MATERIAL AND METHODS: Retrospective observational study of AMP and mAMP cases with laboratory confirmation between 2013 and 2018. We compared clinical and toxicologic variables as well as clinical management between groups. RESULTS: 1) A total of 120 cases were found: 86 (71.7%) with AMP poisoning and 34 (28.3%) with mAMP poisoning. 2) Drug poisoning was confirmed by gas chromatography associated with mass spectrometry (GC-MS) in 787 urine samples found to be positive during screening. One hundred fifty-four (19.6%) were confirmed by GC-MS. Thirtyfour of them did not meet the inclusion criteria. 3) Significant differences between AMP and mAMP cases were found for age (32.3 vs 28.4 y, respectively); sex (72.1% vs 94.1% men); and Spanish nationality (64.0% vs 29.4%). Reasons for admission and clinical features also differed: the reasons were aberrant behavior (15.1% in the AMP group vs 0% in the mAMP group) and palpitations (1.2% vs 20.6%); agitation was observed in 27.9% and 8.8%, respectively. Clinical management was similar in the 2 groups. Multiple drug poisoning was detected in 76.6% patients and was more common in patients in the AMP group (82.6% vs 61.8%). The additional drugs in these cases were mainly cocaine (63.0%), cannabis (48.9%), 3,4-methylenedioxy-N-methamphetamine (MDMA) (38.0%), and alcohol (35.9%). Cannabis was detected in a significantly higher proportion in the AMP group (45.3%) than in the mAMP group (17.6%). False positives were found in 78.7% of the samples. The culprit drug was most often MDMA (71.2%). CONCLUSION: AMP poisonings were associated with age over 30 years, Spanish nationality, aberrant behavior, agitation, multiple drug findings, and the use of cannabis. Poisonings caused by mAMP abuse were associated with age under 30 years, non-Spanish nationality, palpitations, and single-drug use.

4.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936344

RESUMO

Heroin-related myelopathy is an uncommon but often devastating complication of heroin intake. It is usually reported in individuals exposed to intravenous heroin after a variable drug-free period, leading to acute and complete spinal cord injury with poor long-term outcome. We describe an original case of acute longitudinally extensive transverse myelopathy following single heroin and cocaine intravenous exposure after a long period of abstinence confirmed by toxicological hair and retrospective urine drug analysis. This case could provide new insights in the understanding of this rare neurological complication.


Assuntos
Cocaína/administração & dosagem , Incontinência Fecal/fisiopatologia , Cabelo/química , Heroína/efeitos adversos , Mielite Transversa/diagnóstico , Paraplegia/fisiopatologia , Abuso de Substâncias por Via Intravenosa/complicações , Anti-Inflamatórios/uso terapêutico , Cocaína/efeitos adversos , Extinção Psicológica , Incontinência Fecal/etiologia , Feminino , Heroína/administração & dosagem , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/complicações , Mielite Transversa/fisiopatologia , Mielite Transversa/terapia , Paraplegia/etiologia , Índice de Gravidade de Doença , Punção Espinal , Detecção do Abuso de Substâncias/métodos , Resultado do Tratamento
10.
Emergencias (St. Vicenç dels Horts) ; 28(1): 38-40, feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-148465

RESUMO

El objetivo de este estudio es la detección de parámetros analíticos asociados a la mortalidad en los pacientes con diabetes mellitus tipo 2 (DM2) con tratamiento crónico con metformina que acuden a urgencias por un cuadro clínico agudo con presencia de acidosis láctica. Se trata de un estudio observacional-analítico retrospectivo realizado en un hospital de tercer nivel. Se recogieron datos clínicos y analíticos en una serie de pacientes con acidosis láctica, estratificada por gravedad, y tratamiento con metformina para DM2. Se compararon los resultados en función de la mortalidad o supervivencia del episodio. De 16 pacientes estudiados, con una edad media de 70 años (rango de 60 a 77), el 75% presentó sintomatología gastrointestinal los 5 días previos a su ingreso. La mortalidad total observada fue del 19%, que se asoció a la presencia de sepsis al ingreso, leucocitosis con neutrofilia, plaquetopenia, elevación de proteína C reactiva (PCR), valores altos de procalcitonina y la comorbilidad con una o más patologías crónicas. Las cifras sé- ricas de metformina no se correlacionaron significativamente con la mortalidad. Se concluye que en pacientes con acidosis láctica y tratamiento con metformina pueden ser factores asociados a la mortalidad la presencia de criterios de sepsis, neutrofilia con plaquetopenia, elevación de PCR y de procalcitonina y la existencia de una o más patologías comórbidas (AU)


To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/complicações , Acidose Láctica/mortalidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Metformina/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Retrospectivos
11.
Emergencias ; 28(1): 38-40, 2016 02.
Artigo em Espanhol | MEDLINE | ID: mdl-29094825

RESUMO

EN: To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis.

13.
Emergencias (St. Vicenç dels Horts) ; 27(3): 169-173, jun. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-139123

RESUMO

Objetivo. Analizar el rendimiento de un punto de corte de 3 μg/mL en la determinación de paracetamol urinario (PCTo) como método de cribado para detectar paracetamol en posibles sobreingestas en población pediátrica. Método. Estudio de caso-control, observacional, analítico y prospectivo realizado en una unidad de cuidados intensivos pediátricos (UCIP). Se seleccionó una muestra compuesta por aquellos pacientes ingresados en UCIP, considerando el grupo de casos aquellos con administración pautada de una dosis terapéutica endovenosa de paracetamol y un grupo control sin administración del fármaco. Se recogió una muestra de orina dentro de la primera hora y una segunda muestra pasadas 4 horas de la dosis del fármaco. En todos se determinó PCTo cuantitativamente. Se comparó la proporción de pacientes con PCTo _ 3 μg/mL. Se calcularon sensibilidad, especificidad y valores predictivos. Resultados. Se incluyeron 40 niños de edades entre 1 mes y 19 años (20 en cada grupo). No se obtuvo ningún paciente de control con PCTo positiva. La sensibilidad de la prueba en la primera orina recogida fue del 95% (IC 95%: 85,5-100%) y su especificidad del 100%. El valor predictivo positivo fue 100%, y el negativo del 95,2% (IC 95%: 86,1-100%). En las segundas orinas recogidas todos los valores de rendimiento del test fueron del 100%. Conclusión. La detección de PCTo antes de las 4 horas es útil para descartar la ingesta de paracetamol en población pediátrica. Se requieren estudios que permitan validar el nuevo punto de corte de 3 μg/mL para su posible inclusión en el algoritmo de sospecha de intoxicación aguda (AU)


Objective. To analyze the diagnostic yield of a cut-point of 3 μg/mL for paracetamol in urine to screen for poisoning in children. Methods. Prospective case–control observational study in a pediatric intensive care unit (PICU). All enrolled patients had been admitted to the PICU. Cases were children receiving a therapeutic dose of intravenous paracetamol. Controls were not receiving paracetamol. Urine samples were collected early in the morning and 4 hours after a dose of paracetamol was received by case patients. Paracetamol concentration was measured in all samples. We compared the percentages of cases and controls who had a concentration of 3 μg/mL or more. The sensitivity, specificity, and predictive values of the cut-point were calculated. Results. Forty children aged between 1 month and 19 years (20 per matched group) were enrolled. Paracetamol was not detected in any of the control samples. The sensitivity of the test in early morning urine was 95% (95% CI, 85.5%–100%); specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.2% (95% CI, 86.1%–100%). Paracetamol was detected in all of the second samples collected from cases. Conclusions. Measuring the paracetamol concentration in urine within 4 hours of dosing is useful to rule out prior intake of paracetamol and overdosing in PICU patients. Studies to validate the new cut-point of 3 μg/mL for paracetamol in urine are required with a view to possibly including it in a diagnostic protocol for suspected acute poisoning (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Acetaminofen/uso terapêutico , Sensibilidade e Especificidade , Valor Preditivo dos Testes , Envenenamento/complicações , Amostras de Medicamentos , Acetaminofen/toxicidade , Programas de Rastreamento/métodos , Estudos de Casos e Controles , Estudos Prospectivos , Cuidados Críticos/métodos
14.
Emergencias ; 27(3): 169-173, 2015 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-29077309

RESUMO

OBJECTIVES: To analyze the diagnostic yield of a cut-point of 3 µg/mL for paracetamol in urine to screen for poisoning in children. MATERIAL AND METHODS: Prospective case-control observational study in a pediatric intensive care unit (PICU). All enrolled patients had been admitted to the PICU. Cases were children receiving a therapeutic dose of intravenous paracetamol. Controls were not receiving paracetamol. Urine samples were collected early in the morning and 4 hours after a dose of paracetamol was received by case patients. Paracetamol concentration was measured in all samples. We compared the percentages of cases and controls who had a concentration of 3 µg/mL or more. The sensitivity, specificity, and predictive values of the cut-point were calculated. RESULTS: Forty children aged between 1 month and 19 years (20 per matched group) were enrolled. Paracetamol was not detected in any of the control samples. The sensitivity of the test in early morning urine was 95% (95% CI, 85.5%-100%); specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.2% (95% CI, 86.1%-100%). Paracetamol was detected in all of the second samples collected from cases. CONCLUSION: Measuring the paracetamol concentration in urine within 4 hours of dosing is useful to rule out prior intake of paracetamol and overdosing in PICU patients. Studies to validate the new cut-point of 3 µg/mL for paracetamol in urine are required with a view to possibly including it in a diagnostic protocol for suspected acute poisoning.

15.
Nutr. clín. diet. hosp ; 34(3): 105-123, sept.-dic. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-131757

RESUMO

Los efectos beneficiosos del consumo de pescado tanto en niños como en adultos han sido bien reconocidos. Sin embargo, la ingesta de metilmercurio principalmente a través del pescado y marisco contaminado puede producir efectos adversos en la salud. El grupo de estudio para la prevención de la exposición al metilmercurio (GEPREM-Hg), constituido por representantes de diferentes sociedades científicas españolas, ha elaborado un documento de consenso donde se recogen en forma de preguntas y respuestas las principales conclusiones, recomendaciones y propuestas planteadas en el grupo. El objetivo del documento es profundizar en el conocimiento de los factores asociados a la exposición almetilmercurio, los posibles efectos sobre la salud en la población española, los métodos de análisis, la interpretación de los resultados, el coste económico y establecer finalmente recomendaciones de consumo de pescados y mariscos. El grupo considera acertadas todas las iniciativas encaminadas a reducir o prohibir el uso del mercurio y la necesidad de conocer los resultados de los análisis de contaminantes que se realizan en los pescados y mariscos que se comercializan en España. Además, opina que se deberían establecer sistemas de biomonitorización para conocer la evolución de la exposicional metilmercurio en niños y adultos y realizar estudios diseñados para conocer los posibles efectos sobre la salud de las concentraciones halladas en la población española, teniendo en cuenta el estilo de vida, los patrones de consumo alimentarios y la dieta mediterránea (AU)


The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methyl mercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methyl mercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methyl mercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methyl mercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet (AU)


Assuntos
Humanos , Compostos de Metilmercúrio/envenenamento , Contaminação de Alimentos/análise , Fatores de Risco , Frutos do Mar/efeitos adversos , Produtos Pesqueiros/efeitos adversos
16.
Nutr Hosp ; 31(1): 16-31, 2014 Nov 21.
Artigo em Espanhol | MEDLINE | ID: mdl-25561095

RESUMO

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health among the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, ta king into account the lifestyle, eating patterns and the Mediterranean diet.


Assuntos
Compostos de Metilmercúrio/efeitos adversos , Compostos de Metilmercúrio/análise , Alimentos Marinhos/efeitos adversos , Alimentos Marinhos/análise , Adulto , Criança , Consenso , Dieta Mediterrânea , Contaminação de Alimentos/análise , Humanos , Espanha/epidemiologia
17.
Rev. lab. clín ; 3(4): 171-176, oct.-dic. 2010. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-85210

RESUMO

Introducción. El uso del laboratorio es inadecuado (excesivo o innecesario) y es preciso controlarlo. Material y métodos. Elaborar una estrategia para gestionar, según criterios de medicina basada en la evidencia, la derivación de pruebas subcontratadas y comparar los resultados entre dos años consecutivos. Resultados. La demanda se ha reducido un 6,56% y los costes un 26,9%. Es de destacar que solo el 1,9 % de los peticionarios a los que se les ha denegado alguna prueba contacta con el laboratorio para reclamar o mostrar su disconformidad. Conclusiones. El profesional del laboratorio clínico debe implicarse como consultor clínico para mejorar la eficiencia de las pruebas de laboratorio (AU)


Introduction. The use of the laboratory is inadequate and it is necessary to control it. Materials and methods. To elaborate a strategy to manage, according to evidence-based medicine criteria, the origin of requested tests and to compare the results between two consecutive years. Results. The demand has reduced by 6.56% and the costs by 26.9%. It is worth emphasizing that only 1.9% of the requesters, for which some test has been refused, contacts the laboratory to show disapproval. Conclusions. The professionals of the clinical laboratory must be involved in their function as clinical consultant to improve the efficiency of laboratory tests (AU)


Assuntos
Humanos , Masculino , Feminino , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico , Atenção Primária à Saúde/ética , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/ética , Encaminhamento e Consulta/organização & administração , Técnicas de Laboratório Clínico/classificação , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/ética , Técnicas de Laboratório Clínico/tendências
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