[Adequacy of the admissions and care provided to the patients with community-acquired pneumonia]. / Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad.

BACKGROUND: The purpose of this study has been to know the adequacy of the hospital admissions of patients with community-acquired pneumonia (CAP), applying the Fine Modified Forecast Classification Rule and if patient care is performed in accordance with the indicators for quality by the Infectious Diseases Society of America (IDSA) recommendations. PATIENTS AND METHODS: A cross-sectional and retrospective study analyzing the appropriateness of hospital admissions of all patients treated for CAP at the Hospital Clínico Universitario de Valladolid during 2006. All patients were interviewed with the classification rules for Fine Modified Forecasting to evaluate the adequacy of hospital admissions through the analysis of associated comorbidity, severity parameters and quality indicators. RESULTS: We detected 23 cases (6.07%) of CAP inadequately admitted, 5 of whom were Class I (21.7%), 10 Class II (43.4%) and 8 Class III (34.7%). COPD (32.5%) and hypoxemia (36%) were the comorbidities and risk factors most involved in the admission of low-risk CAP. A total of 25 (32.89%) inadequate discharges were observed from the Emergency Service and the following was found in regard to their Pneumonia Severity Index (PSI): Class I: 2 (8%), Class II: 10 (40%) Class III: 7 (28%), Class IV: 4 (16%), Class V: 0; Fine Unknown: 2. The most important comorbidity in inadequate discharges was 10 for COPD (40%). The following were performed: blood cultures in 160 cases (42.2%), chest x-ray in 379 (100%), gas and/or pulse measurement in 379 (100%), and measurement of Ag S. pneumoniae and Legionella in urine in 14 (87.5%) of the 16 cases of CAP that required admission to the ICU. CONCLUSION: The Fine Modified Forecasting Classification Rule can be very useful in assessing adequacy of admissions and to decide the need for hospital admission due to CAP. Adequate care for patients with CAP according to the quality indications established by the IDSA stands out.

[Doubts and confusions in the diagnosis and treatment of positional plagiocephaly. Management protocol]. / Enigmas y confusiones en el diagnóstico y tratamiento de la plagiocefalia posicional. Protocolo asistencial.

INTRODUCTION: Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is considerable confusion in the literature on the terminology and physiopathology of this deformity, as well as its differential diagnosis with true synostosis and treatment recommendations. OBJECTIVES: To clarify these concepts and present a protocol for the management of positional plagiocephaly, which was recently requested by the Health Administration of the Community of Madrid. PROTOCOL: The protocol aims to achieve coordination among pediatricians and neurosurgeons, as well as to provide precise information on this deformity for parents, pediatricians and neurosurgeons. MATERIAL AND METHODS: Previous consensus was reached on a series of data. Infants were classified into three categories of deformity (mild, moderate, severe) according to measurements on digital photographs. Diagnosis and treatment follows two phases: a pediatric phase (up to 5 months of age) and a neurosurgical phase (from 5 months onwards). Infants are referred to neurosurgical consultation only after being treated with postural changes and physiotherapy and only after reaching the age of 5 months. The reasons for this approach are explained in the protocol, which also defines the functions and responsibilities of each specialty. CONCLUSION: The treatment proposed in the protocol is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.

[Urgent care of the diabetic patient in the province of Valladolid]. / Asistencia urgente del paciente diabético en el área este de la provincia de Valladolid.

OBJECTIVE: To know the cause of admissions of diabetic patients at an emergency room in eastern Valladolid in a year. METHODS: It is a retrospective and transversal study that analysed a number of the admission of diabetic patients at an emergency room because of a direct complication of diabetes mellitus or another different cause. We used t and chi 2 as statistic tests, considering 0.05 as significance. RESULTS: Up to 2,433 (2.4%) were diabetes mellitus emergencies. 17.1% because of a direct complication, most of them metabolic complications (24.6% hyperglycaemia). CONCLUSION: We emphasize the high prevalence of direct complications as emergency admissions in our hospital.

[Micronodular pulmonary infiltration as first manifestation of metastatic hepatocellular carcinoma]. / Infiltrado pulmonar micronodular como primera manifestación de un carcinoma hepatocelular metastásico.

Infectious diseases, as tuberculosis, and metastatic cancers are the main causes of multiple pulmonary micronodules on chest radiographs. Many cancers can produce this anomaly, but the most common are thyroid, melanoma and gastrointestinal (colon and pancreas). Hepatocellular carcinoma can produce lung metastasis, but seldom makes bilateral pulmonary micronodules. Here we present the case of a woman with a hepatocarcinoma that appeared as a bilateral micronodular disease on the chest radiograph.

[Analysis of 83 bronchospasm episodes seen at urgent care during one spring night]. / Análisis de 83 episodios de broncoespasmo atendidos una noche de primavera en urgencias.

BACKGROUND: The new treatments for the bronchial inflammation in asthma, have contributed to decrease the mortality rate. However, there is still a group of population with no diagnosis fo asthma, who requires urgent medical attention in situations such as air pollution or risen pollen levels. On 2nd June 2000, 83 subjects with an acute crisis of asthma, came to the Emergency Room in our Hospital in just 6 hours, coinciding with the highest annual pollen measurement and a strong storm. METHODS AND RESULTS: Personal data from those 83 patients, medical behaviour at the Casualty and post-attention recommendations were considered for analysis. 21 % never had previous diagnosis of asthma and 93 % followed no regular medical control. 61.45 % did no treatment. A chest radiography was taken in 53.76 % of the patients. Salbutamol was administrated in most of them (92.18 %) and parentally administration of steroids in 23.47 %. 21 % were referred to an specialist. CONCLUSIONS: A significant rate of asthmatics is under-diagnosed, under-controlled and under-treated. Public Health authorities should consider the creation of new Allergy Units, a fluid communication between general practitioners and specialists, and the monitorization of pollen recounts with special plans of emergency situations to contribute to solve this problem.