Retrospective study of polytrauma patients's medical records that presented abdominal trauma, comperad to abdominal trauma and extra-abdominal injuries

This study sought to retrospectively assess the relationship between intra and extra-abdominal injuries in polytrauma patients undergoing laparotomy at the Regional University Hospital of Maringá between 2017 and 2018.This study was based on 111 electronic medical records from the Brazilian public health system "SUS", admitted to the hospital due to trauma and undergoing laparotomy, comparing two groups: abdominal injury without extra-abdominal injury (WoEI) and abdominal injury with extra-abdominal injury (WiEI).A total of 111 medical records were analyzed, 57 from 2017 and 54 from 2018. Of these 111records, 43 (39%) were trauma victims with only abdominal injuries and 68 (61%) trauma victims with abdominal and extra-abdominalinjuries. Most patients were male (85%), with an average age of 33 years, ranging from 14 to 87 years. In statistical analysis, according to the T-test, there was significance (p > 0.05) between the WoEI and WiEI groups for data collected regarding death rates and hospitalization days. As for the morbidity rate and difference between genders (male and female), there was no statistical significance (p < 0.05).Polytraumapatients are exposed to greater kinetic energy, with more severe conditions and therefore required more in-hospital care.

El adolescente con cardiopatía congénita: transición y transferencia / The adolescent with congenital heart defects: transition and transfer

Introducción: Los grandes avances en el diagnóstico y tratamiento de los pacientes con cardiopatías congénitas en las últimas décadas han permitido que mas del 90% lleguen a la adolescencia y edad adulta. Sin embargo, muchos de ellos requirieran seguimiento e intervenciones de por vida, por lo que necesitaran ser transferidos desde el hospital pediátrico al de adultos. Material y Métodos: Se incluyeron los pacientes mayores de 15 años que consultaron en el área ambulatoria del servicio de cardiología del Hospital Garrahan durante el periodo agosto 2017 - agosto 2018. Las variables analizadas fueron: procedencia, cardiopatía de base y variedad pronostica ,procedimientos intervencionistas factores asociados como síndrome genéticos y otras comorbilidades, cobertura social, nivel educativo, terapéutica medicamentosa, clase funcional, embarazos, prevalencia de cardiopatías en la descendencia y transición-transferencia al hospital de adultos. Resultados: Registramos 704 consultas de 309 pacientes con una edad media de 19,17 años (DS +- 4,62; (rango 15- 49,4 años). Fueron 112 mujeres y 197 varones. El 51,1 % provenían de Buenos Aires,40 % de las provincias del interior y 8,1% CABA. El 92% de los pacientes tenía cardiopatías de moderada y severa complejidad, y el 93,5% eran operadas. El 13,2 % eran síndromes genéticos. El 48.5% tenían comorbilidades, siendo los trastornos electrofisiológicos los más frecuentes en el 72,66% de los casos. El 63% tenía cobertura social pero solo el 2,6% prepagos con cobertura en centros alta complejidad. El 23.6% recibía terapia combinada con 2 o más drogas. El 48,78% ya presentaban antecedente de algún tipo de reintervención, 98,5% de estas se vincularon a las cardiopatías moderadas a complejas. Registramos 15 embarazos con 14 recién nacidos vivos, 1 con cardiopatía congénita. El proceso de transición ­ transferencia en el 55% (170 p) se había iniciado, siendo efectiva (8p), frustra (9p), compartida (49 p), y en proceso (103 p). Hubo un solo fallecimiento durante el periodo de estudio, vinculado a cardiopatía compleja, múltiples reintervenciones y endocarditis. Conclusiones: El 92% de los pacientes en nuestro estudio, tienen cardiopatías operadas de moderada y severa complejidad. Los trastornos electrofisiológicos y la necesidad de reintervenciones durante el seguimiento alejado han sido las complicaciones más frecuentes de esta población. El proceso de transición y transferencia desde el hospital pediátrico al de adultos es deficitario, principalmente por falta de cobertura y experiencia sobre todo para la atención continua de las cardiopatías moderadas y complejas (AU)

Introduction: In recent decades, important advances in the diagnosis and treatment of patients with congenital heart defects have allowed more than 90% of them to reach adolescence and adulthood. However, many patients required lifelong follow-up and interventions, and therefore the need to be transitioned from pediatric to adult care. Material and Methods: Patients older than 15 years who consulted at the outpatient clinic of the department of cardiology at Garrahan Hospital from August 2017 to August 2018 were included. The variables analyzed were place of origin, underlying heart disease, and diagnosis, interventions, associated factors, such as genetic syndromes and other comorbidities, insurance coverage, educational level, pharmacological treatment, functional class, pregnancies, prevalence of heart disease in offspring, and transition-transfer to adult hospital. Results: We recorded 704 consultations from 309 patients with an average age of 19.17 years (SD +- 4.62; range 15-49.4 years); 112 patients were female and 197 male. Overall, 51.1% came from the province of Buenos Aires, 40% from the other provinces, and 8.1% from the city of Buenos Aires. Of the patients, 92% had moderate and severe heart disease, and 93.5% had undergone surgery. Genetic syndromes were identified in 13.2%. Overall, 48.5% had comorbidities, of which electrophysiological disorders were the most common in 72.66% of cases. 63% had social insurance coverage but only 2.6% had a prepaid insurance with coverage in tertiary-level centers. Overall, 23.6% received combination therapy with 2 or more drugs. 48.78% had undergone some type of previous reintervention, 98.5% of whom had moderate-to-severe heart disease. We recorded 15 pregnancies with 14 live neonates, one of whom had congenital heart defects. The transition - transfer had been initiated in 55% (170 p) and was effective (8p), frustrated (9p), shared (49 p), or in progress (103 p). There was only one death during the study period, related to severe heart disease, multiple reinterventions, and endocarditis. Conclusions: 92% of patients in our study have moderate or severe operated heart disease. Electrophysiological disorders and the need for reintervention during the long-term follow-up were the most common complications of this population. The process of transition and transfer from pediatric to adult care is deficient, mainly due to lack of insurance coverage and experience especially for the ongoing care of moderate-to-severe heart disease

Alcohol and tobacco use and the diseases treated in general practice / Uso de álcool e tabaco e as doenças tratadas em ambulatório de clínica geral

Summary Objective: To characterize the use of alcohol and tobacco and correlate both to the diseases of outpatients in a general practice outpatient clinic. Method: The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) questionnaire was answered by 300 randomly chosen subjects assigned to different groups according to the diseases being treated at the Outpatient General and Teaching Clinic of the Department of Internal Medicine, Hospital das Clínicas of the University of São Paulo's School of Medicine (HC-FMUSP, in the Portuguese acronym), São Paulo, Brazil. The consumption of tobacco and alcohol was characterized and its correlation with the groups of diseases being treated was calculated using Chi-square and Pearson test statistics. Results: Compared to alcohol, tobacco use was more prevalent, more intense and showed more health-, social-, legal- and financial-related damage. Tobacco smoking presented a positive significant (p<0.0001) correlation with respiratory diseases. According to the questionnaire's criteria, few alcohol users would be referred to clinical interventions in comparison to smokers. Conclusion: Respiratory diseases and tobacco use were well correlated based on the ASSIST questionnaire. The preventive value of the questionnaire was more evident in relation to tobacco than alcohol consumption.

Resumo Objetivo: Caracterizar o consumo de álcool e tabaco e correlacioná-lo às doenças em tratamento de pacientes de um ambulatório de clínica geral. Método: As perguntas do ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) foram respondidas por 300 pacientes escolhidos aleatoriamente e enquadrados em grupos conforme os diagnósticos das doenças em tratamento no Ambulatório Geral e Didático (AGD), Serviço de Clínica Geral do HC-FMUSP; o consumo das substâncias foi caracterizado e a sua correlação com as doenças em tratamento foi calculada por meio do método do Qui-quadrado e teste de Pearson. Resultados: O consumo de tabaco mostrou-se mais prevalente, mais intenso e maior causa de complicações (de saúde, sociais, legais ou financeiras) do que o do álcool; o consumo de tabaco apresentou correlação positiva e significante (p<0,0001) com a referência de doença respiratória no prontuário médico. De acordo com o critério proposto no questionário, poucos consumidores de bebida alcoólica seriam encaminhados para intervenção preventiva, ao contrário do que ocorreria com os fumantes. Conclusão: A aplicação do ASSIST permitiu caracterizar e correlacionar positivamente o uso de tabaco com doenças respiratórias em tratamento. A importância do questionário como instrumento preventivo das consequências do tabagismo ficou mais evidente do que em relação às associadas ao consumo de bebida alcoólica.

Clinical pharmacology profile of care in Hepatology clinic / Perfil clínico farmacológico dos atendimentos no ambulatório de Hepatologia

Summary Since 2010, the Clinical Gastroenterology and Hepatology Division of the Central Institute of Hospital das Clínicas of the University of São Paulo Medical School (HC-FMUSP, in the Portuguese acronym) has been developing specialized electives assistance activities in the Outpatient Specialty Clinic, Secondary Level, in São Paulo NGA-63 Várzea do Carmo. The objective of this study was to analyze the pharmacotherapeutic profile of patients. This is a cross-sectional and retrospective study in which patients were seen at the Hepatology sector and the results were submitted to descriptive statistics. During the study period, 492 patients were treated at the clinic, with a mean age of 58.9 years and frequency of 61.2% female and 74.8% living in São Paulo. This population was served by various other medical specialties (cardiology and endocrine among others) and the major liver diagnoses were: chronic hepatitis B and C and fatty liver. Comorbidities were also identified, such as diabetes, hypertension and dyslipidemia. Most patients took their medication in the Basic Health Units. We found that 30% of patients use of more than five medications and the most prescribed were omeprazole 208 (42.3%), metformin 132 (26.8%) and losartan 80 (16.3%). Because it is an adult/elderly population, with several comorbidities and polymedication, it is important to be aware of the rational use of medication. The multidisciplinary team is important in applying correct conducts for the safe use of medicines, to reduce the burden on health spending and improving the quality of life of patients.

Resumo Desde 2010, a Divisão de Gastroenterologia e Hepatologia Clínica do Instituto Central do HC-FMUSP tem desenvolvido atividades assistenciais eletivas especializadas em Hepatologia no Ambulatório de Especialidades Nível Secundário de São Paulo no Estado de São Paulo NGA-63 Várzea do Carmo. O objetivo do estudo é analisar o perfil farmacoterapêutico dos pacientes. Trata-se de um estudo transversal e retrospectivo, no qual pacientes foram atendidos pelo setor de Hepatologia e os dados encontrados foram submetidos à estatística descritiva. Os resultados demonstraram que 492 pacientes foram atendidos nesse ambulatório durante o período do estudo com a média de idade de 58,9 anos, frequência de 61,2% do sexo feminino e 74,8% residindo na capital paulista. Essa população foi atendida por outras diferentes especialidades médicas (cardiologia e endócrino, entre outras), e os principais diagnósticos hepáticos foram hepatite crônica B e C e esteatose hepática. Também foram identificadas comorbidades como diabetes, hipertensão arterial e dislipidemia. Boa parte da população tende a retirar a sua medicação nas Unidades Básicas de Saúde. Foi verificado que 30% dos pacientes fazem uso de mais de cinco medicamentos, sendo os mais prescritos o omeprazol (208; 42,3%), metformina (132; 26,8%) e losartana (80; 16,3%). Por se tratar de uma população adulta/idosa, com diversas comorbidades e com polimedicação, é importante estar atento ao uso racional do medicamento. O atendimento da equipe multiprofissional é importante para aplicar tomadas de condutas corretas para a segurança no uso de medicamentos e diminuir a oneração em gastos em saúde, melhorando a qualidade de vida do paciente.

Factores de riesgo para la infección por el virus de la hepatitis C en la Costa Caribe colombiana: un estudio de casos y controles / Risk factors for hepatitis C virus infection in the Colombian Caribbean coast: A case-control study

Resumen Introducción. Se estima que, aproximadamente, 6,8 a 8,9 millones de personas están infectadas por el virus de la hepatitis C en Latinoamérica, de las cuales menos del 1 % llega a recibir tratamiento antiviral. En los estudios llevados a cabo hasta ahora en Colombia, se ha propuesto determinar la prevalencia de la enfermedad en algunos grupos de riesgo, y no se ha hecho el análisis de otros factores potencialmente implicados en el contagio. Objetivos. Determinar los factores de riesgo tradicionalmente analizados y otros no estudiados antes para la hepatitis C crónica en la Costa Caribe colombiana. Materiales y métodos. Se hizo un estudio de casos y controles (1:3) emparejados por empresa promotora de salud y edad (± 10 años), en el primer nivel de atención de hepatología y gastroenterología. A todos los pacientes positivos en la prueba ELISA se les hizo una prueba confirmatoria de carga viral. En el análisis de regresión logística multivariable se determinaron los factores predictores independientes de infección. Resultados. La transfusión sanguínea (odds ratio, OR=159,2; IC95% 35,4-715; p<0,001) y el antecedente de hospitalización antes de 1994 (OR=4,7; IC95% 1,3-17,1; p=0,018) se determinaron como los dos únicos factores independientes predictores de infección. Conclusión. Es necesario comprobar la reproducibilidad de estos resultados y hacer estudios de costo-efectividad antes de recomendar su utilización en el diseño de nuevas estrategias de cribado.

Abstract Introduction: An estimated 6.8-8.9 million people are infected with hepatitis C virus in Latin America, of which less than 1% receives antiviral treatment. Studies so far in Colombia have attempted to determine the prevalence of the disease in some risk groups, thus preventing the identification of other factors potentially involved in the spread of the infection. Objectives: To identify traditional and non-traditional risk factors for chronic hepatitis C in the Colombian Caribbean coast. Materials and methods: This was a case-control study (1:3) matched by health care provider and age (± 10 years) conducted at the primary care level of gastroenterology and hepatology outpatient services. All patients with a positive ELISA underwent a confirmatory viral load test. A multivariate logistic regression analysis identified the independent predictors of infection. Results: Blood transfusion (OR=159.2; 95% CI: 35.4-715; p<0.001) and history of hospitalization before 1994 (OR=4.7; 95% CI: 1.3-17.1; p=0.018) were identified as the only two independent predictors of infection. Conclusion: It is necessary to check the reproducibility of these results and to conduct cost-effectiveness studies before recommending their use in the design of new screening strategies.

A time series analysis of meteorological factors and hospital outpatient admissions for cardiovascular disease in the Northern district of Guizhou Province, China

Findings on the effects of weather on health, especially the effects of ambient temperature on overall morbidity, remain inconsistent. We conducted a time series study to examine the acute effects of meteorological factors (mainly air temperature) on daily hospital outpatient admissions for cardiovascular disease (CVD) in Zunyi City, China, from January 1, 2007 to November 30, 2009. We used the generalized additive model with penalized splines to analyze hospital outpatient admissions, climatic parameters, and covariate data. Results show that, in Zunyi, air temperature was associated with hospital outpatient admission for CVD. When air temperature was less than 10°C, hospital outpatient admissions for CVD increased 1.07-fold with each increase of 1°C, and when air temperature was more than 10°C, an increase in air temperature by 1°C was associated with a 0.99-fold decrease in hospital outpatient admissions for CVD over the previous year. Our analyses provided statistically significant evidence that in China meteorological factors have adverse effects on the health of the general population. Further research with consistent methodology is needed to clarify the magnitude of these effects and to show which populations and individuals are vulnerable.

Síndrome febril prolongado: un desafío para el infectólogo pediatra / Fever of unknown origin: a challenge for the pediatric infectious diseases specialist

Introduction: Prolonged febrile syndrome (PFS) is defined as fever 7-10 days, with initial study does not allow etiologic diagnosis. Objective: To describe the main causes of the PFS and its temporal behavior in Pediatric Infectious Diseases Unit Outpatient Care of Complejo Asistencial Dr. Sótero del Río (CASR). Patients and Methods: A descriptive, prospective study between january 2007-december 2012, about 153 patients from 6 weeks to 14 years 11 months old, diagnosed with PFS, tab completing clinical and laboratory monitoring. Results: etiology was obtained in 67.9%, the causes were infection (88.4%), neoplasms (4.8%), rheumatological (4.8%) and Kawasaki disease (2.8%). The most important infectious causes were enteric fevers (typhoid and paratyphoid) (18.4%), urinary tract infection (11.9%), Bartonella henselae infections and adenovirus (8.7%) each one and Epstein Barr virus (7.6%). Ninety eight percent of patients had complete resolution, 60.7% did not require hospitalization and mortality was 0%. Discussion: As in previous pediatric clinical series the infections were the most frequent causes. Enteric fever persists as principal cause, however, the epidemiological evidence is oscillating in time endorsing the local statistics can count over the years to improve the diagnostic and therapeutic approach.

Introducción: El síndrome febril prolongado (SFP) se define como fiebre entre 7-10 días, con estudio inicial que no permite un diagnóstico etiológico. Objetivo: Describir las principales etiologías del SFP y su comportamiento temporal en la unidad de infectología pediátrica ambulatoria del Complejo Asistencial Dr. Sótero del Río (CASR). Pacientes y Método: Estudio descriptivo, prospectivo, entre enero de 2007-diciembre de 2012. Análisis de 153 pacientes entre 6 semanas y 14 años 11 meses de edad, con diagnóstico de SFP, que completaron ficha de seguimiento clínico-laboratorial. Resultados: Se obtuvo diagnóstico etiológico en 67,9%, las causas fueron: infecciones (88,4%), neoplasias (4,8%), reumatológicas (4,8%) y enfermedad de Kawasaki (2,8%). Las causas infecciosas más importantes fueron: fiebres entéricas (tifoidea y paratifoidea) (18,4%), infección del tracto urinario (11,9%), enfermedades por Bartonella henselae y adenovirus (8,7%) cada uno y virus de Epstein Barr (7,6%). El 98% de los pacientes tuvo resolución completa, 60,7% no requirió hospitalización y no se registraron decesos. Discusión: Como en las series clínicas antes publicadas, las infecciones fueron la causa más frecuente de SFP. La fiebre entérica persiste como causa principal; sin embargo, se evidencia una situación epidemiológica oscilante en el tiempo justificando la necesidad de contar con estadísticas locales a lo largo de los años para mejorar el enfoque diagnóstico y terapéutico.

Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a Central West Bank Hospital

We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs [NSAIDs] and antibiotics [ATBs] at a central hospital in the West Bank, Palestine. This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Of the total prescriptions, 410 contained NSAIDs [18.6%], including diclofenac [40.2%], low dose aspirin [23.9%], ibuprofen [17.8%] and indomethacin [15.1%]. A minority of these prescriptions contained a combination of these agents [2.5%]. Only one prescription contained cyclooxyeganse-2 inhibitors [0.2%]. The appropriateness of NSAID use to the diagnosis was as follows: appropriate [58.3%], inappropriate [14.4%] and difficult to tell [27.3%]. The rate of ATB use was 30.3% [669 prescriptions]. The ATBs prescribed were amoxicillin [23.3%], augmentin [14.3%], quinolones [12.7%], first and second generation cephalosporins [9.4% and 12.7%, respectively] and macrolides [7.2%]. ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole [4.3%]. Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents

High prevalence of late diagnosis of HIV in Mexico during the HAART era

OBJECTIVE: To evaluate the prevalence of late HIV diagnosis (CD4<200 cell/mm³) in an HIV clinic in Mexico City between 2001-2008, to assess changes in this prevalence across the study period, and to determine the risk factors associated to late testing (LT). MATERIALS AND METHODS: Cross-sectional analysis including all patients recently diagnosed as HIV. We estimated the proportion of LT patients and compared demographic characteristics between those and all other. We determine the risk factors associated to LT using logistic regression methods. RESULTS: Sixty one percent of LT patients present when are diagnosed for the first time. The prevalence did not decrease between 2001 and 2008 (p=0.37). Older age (OR: 2.4; 95%CI 1.2-4.7), unemployment (OR: 1.75; 95%CI 1.12-2.75) and less than nine years of education (OR: 2.44; 95%CI 1.37-4.33) were independently associated to LT, in a multivariate analysis. CONCLUSION: LT has high prevalence in Mexico, this impact on antiretroviral effectiveness and perhaps on HIV transmission. Policies for HIV-prevention in Mexico need to be modified to reduce LT prevalence including more aggressive strategies of testing.

OBJETIVO: Estimar la prevalencia de diagnóstico tardío (DT) (CD4<200 cel/mm³) de VIH en una clínica en la Ciudad de México entre 2001 y 2008, evaluar cambios en la prevalencia en este periodo y determinar factores de riesgo asociados con el DT. MATERIAL Y MÉTODOS: Mediante un estudio de cohorte transversal de pacientes de VIH se estimó la proporción de pacientes con DT y se compararon sus características demográficas con pacientes sin DT. Se evaluaron los factores de riesgo asociados a DT usando regresión logística. RESULTADOS: Se encontró una prevalencia de DT de 61%, sin cambios entre 2001-2008 (p=0.37). Mayor edad (RM: 2.4; 95%IC 1.2- 4.7), desempleo (RM: 1.75; 95%IC 1.12-2.75) y menos de nueve años de educación (RM: 2.44; 95%IC 1.37-4.33) fueron independientemente asociados a DT. CONCLUSIONES: El DT tiene alta prevalencia en México. Esto impacta en la efectividad de tratamiento antirretroviral y posiblemente en la transmisión del VIH. Deben dirigirse políticas de prevención a reducir el DT mediante estrategias agresivas de diagnóstico.

Incidence of congenital hypothyroidism in the city of Uberaba/Minas Gerais and etiological evaluation of the affected subjects / Incidência do hipotireoidismo congênito no município de Uberaba/Minas Gerais e avaliação etiológica dos afetados

OBJECTIVE: The objective of this study was to determine the incidence and etiology of congenital hypothyroidism (CH) in Uberaba, MG. SUBJECTS AND METHODS: From 2001 to 2010, by reviewing patient files from a public reference outpatient unit. The screening program covered 88% of live-born children. RESULTS: CH was diagnosed in 16 children, representing an incidence of 1:2,017 live-born children screened. The etiological evaluation was done in 15 children and revealed seven cases of thyroid dysgenesis, seven of dyshormonogenesis, and one case of transient hypothyroidism. One child moved away from the state before etiological investigation was carried out. CONCLUSION: We concluded that both the incidence of CH and of dyshormonogenesis as the main causes of CH were increased in the investigated region, but molecular studies are necessary for a better definition of etiology.

OBJETIVO: O objetivo deste estudo foi determinar a incidência e etiologia do hipotireoidismo congênito (HC) em Uberaba, MG. PACIENTES E MÉTODOS: Mediante revisão dos prontuários de pacientes atendidos no ambulatório de referência do serviço público, no período de 2001 a 2010. RESULTADOS: A cobertura do programa foi de 88%, sendo diagnosticadas 16 crianças com HC, com incidência de 1:2.017 nascidos vivos investigados. A avaliação etiológica foi realizada em 15 crianças, sendo diagnosticados sete casos de disgenesia tireoidiana, sete casos de disormonogênese e um caso de hipotireoidismo transitório. Uma criança não foi investigada devido à mudança de residência para outro estado. CONCLUSÕES: Concluímos que a incidência do HC é maior nesta região, assim como a disormonogênese como principal causa, sendo necessários estudos moleculares para melhor definição etiológica.

Primer Centro de Medicina del Viajero en un hospital público de la Provincia de Buenos Aires, República Argentina: Dos años de experiencia / First Travel Medicine Center in a public hospital from Buenos Aires Province, Argentina Republic: The first 2 years of experience

Introduction: Although Buenos Aires is the biggest province in Argentina, there was no program for Travel Medicine in any public hospital until 2008, when the Travel Medicine Center (CEMEVI) was established in our hospital. Objective: To analyze the first 24 months of experience in the CEMEVI. Results: A total of 278 travelers were assisted. Most of them consulted before traveling (pre-travel visits). The most common destinations were countries in South America and urban as well as rural areas. Travelling to malaria and yellow fever endemic countries represented 35% and 16% of the total of destinations, respectively. Only 4% were post-travel interviews. Conclusion: It is feasible and frutful to implement a Travel Medicine Center in the public health system.

Introducción: La Provincia de Buenos Aires, a pesar de ser la mayor de nuestro país, no contaba con ningún sitio de asesoramiento al viajero instalado en un hospital público, hasta que en el año 2008 se crea el Centro de Medicina del Viajero (CEMEVI) en nuestro hospital. Objetivo: analizar de manera retrospectiva los primeros 24 meses de experiencia en el CEMEVI. Resultados: Recibimos un total de 278 consultas, la mayoría durante el pre-viaje, a países de América del Sur, a sitios urbanos- rurales, de los cuales 35 y 16% de los viajeros visitaron zonas de riesgo para malaria y fiebre amarilla, respectivamente. Sólo 4% de las consultas fueron en el post-viaje. Conclusión: Es posible y fructífero implementar un Centro de Medicina del Viajero en el sector público de salud.

The one-stop clinic as the standard of out-patient care in a hospital urology department

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2 percent of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75 percent) and urinary tract infection (73 percent). Other health problems, such as haematuria (62 percent) and renal colic (46 percent), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

Changing trends of services used as first contact by patients with mental health problems.

Background. In the past, traditional faith healers and practitioners of alternative medicine have often been reported to be the first source of contact for Indian patients with mental health problems. However, over the past few decades, this trend seems to be changing. Method. Using a semi-structured questionnaire, we assessed 200 new patients at a psychiatric outpatient service in a general hospital for the first service contact used by them for their mental health problems. Results. Psychiatrists, non-psychiatric physicians, traditional faith healers and practitioners of alternative medicine were the first service contact for 91 (45.5%), 88 (44%), 16 (8%) and 5 (2.5%) patients, respectively. Patients suffering from severe mental illnesses were more likely to choose a psychiatrist as the first contact, whereas those with neurotic, stress-related and organic mental disorders contacted a non-psychiatric physician. Conclusion. In the current scenario, psychiatrists and nonpsychiatric physicians serve as the first service contact for most patients with mental health problems in India, though traditional faith healers and practitioners of alternative medicine are contacted by a minority.

Outpatient Quick Diagnosis Units for the evaluation of suspected severe diseases: an observational, descriptive study

BACKGROUND: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS: Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN: Observational, descriptive study. METHODS: Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS: In 88 percent of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8 percent; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18 percent). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS: Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.

Evolução e viabilização de um centro cirúrgico ambulatorial para cirurgias de catarata em larga escala em um hospital universitário / Evolution and viability of an outpatient surgery center for cataract surgery on a large scale in a university hospital

Objetivo: Analisar a evolução do número de cirurgias realizadas no centro cirúrgico ambulatorial de um hospital universitário e avaliar sua viabilidade financeira durante e após a interrupção da Campanha Nacional de Catarata em 2006. Métodos: Foi realizado um estudo analítico retrospectivo entre 2005 e 2009 no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) em que foram avaliados a viabilidade econômica do centro cirúrgico ambulatorial, o número de cirurgias de catarata realizados e o número de cirurgiões presentes diariamente naquela unidade. Resultados: Seria necessária a realização de pelo menos 400 procedimentos mensais para garantir a viabilidade financeira do centro cirúrgico ambulatorial. Este número ficou abaixo do esperado nos anos de 2008 e 2009 (média de 370,6 e 390,1 cirurgias respectivamente). O número de estagiários de catarata diminuiu de 13 em 2005 para 3 em 2009. Conclusão: O principal fator para a redução no número de cirurgias de catarata realizadas no centro cirúrgico ambulatorial após 2006 foi a dificuldade de acesso da população necessitada ao hospital, decorrente de restrições à realização de projetos de triagem. A maior utilização das salas cirúrgicas por outras clínicas e a diminuição na admissão de novos cirurgiões, adequaram e viabilizaram o centro cirúrgico ambulatorial para a nova realidade políticoeconômica.

Purpose: To analyze the number of surgeries performed in outpatient surgical center at a university hospital and to assess its financial viability during and after the interruption of the Cataract National Campaign in 2006. Methods: Retrospective analytical study between 2005 and 2009 at the Clinical Hospital of the University of São Paulo (HC-FMUSP) which evaluated the economic viability of the outpatient surgical center, the number of cataract surgeries performed and the number of surgeons present daily in that unit. Results: It would be necessary to perform at least 400 procedures monthly to ensure the financial viability of the outpatient surgical center. This number was lower than the expected in the years of 2008 and 2009 (average of 370.6 and 390.1 surgeries respectively). The number of cataract fellows decreased from 13 in 2005 to 3 in 2009. Conclusion: The main factor for the reduction in the number of cataract surgeries performed in the outpatient surgical center after 2006 was the difficulty of access of the population to the hospital due to restrictions on the development of screening projects. The increased use of the operating rooms by other clinics and the decrease in the admission of new surgeons, made the outpatient surgical center appropriate and viable for the new political-economic reality.

Medicación potencialmente inapropiada en ancianos en un hospital de primer nivel, Bogotá 2007 / Potentially inappropriate medication in elderly in a first level hospital, Bogota 2007

Objetivo Describir la medicación potencialmente inapropiada en ancianos (MPIA) atendidos en consulta ambulatoria en primer nivel en Bogotá en 2007. Metodología Se realizó un estudio de corte transversal, como criterios de MPIA se utilizaron los propuestos por Beers actualizados en 2002. La información se obtuvo de una muestra aleatoria de 423 pacientes mayores de 65 años que asistieron a 16 unidades de atención primaria, se revisó la última consulta registrada en el año en la historia clínica. Resultados El promedio de medicamentos prescritos fue de 3,017, el 71,9 por ciento de los pacientes estaba polimedicado. Los grupos de medicamentos más frecuentemente prescritos fueron con acción sobre el sistema del sistema cardiovascular (33,9 por ciento), tracto alimentario y metabolismo (17,6 por ciento) y sistema músculo esquelético (10,6 por ciento). Según los criterios de Beers 21,5 por ciento de los pacientes recibieron MPIA. Se encontró asociación de la MPIA con la polimedicación. Hubo mayor frecuencia de MPIA en pacientes con diagnósticos de enfermedades de sistema músculo esquelético y del tejido conectivo y del sistema circulatorio y con la prescripción de fármacos que actúan sobre el sistema músculo esquelético, el sistema nervioso y el sistema respiratorio. Al 25,1 por ciento de los pacientes le prescribieron medicamentos que pueden generar problemas no clasificados como MPIA por Beers. Conclusiones La MPIA es un problema frecuente, es necesario adecuar y complementar los criterios de Beers a cada realidad, además de describir la MPIA es necesario estudiar sus causas.

Objective To describe the potentially inappropriate medications in the elderly (PIME) treated at outpatient consultation in the first level in Bogota in 2007. Methodology A cross sectional study was developed, updated in 2002 Beers criteria were used as PIME. The information was obtained from a random sample of 423 outpatients older than 65 years attending at 16 primary care units, reviewing last recorded in year in the clinical history. Results The average number of drugs prescribed was 3,017, 71.9 percent of the patients were on polymedication. Drug groups more frequently prescribed were those acting on cardiovascular (33.9 percent), alimentary tract and metabolism (17.6 percent) and musculoskeletal (10.6 percent) system. According to the Beers criteria 21,5 percent of patients received PIME. There was an association of polypharmacy with PIME. PIME was more frequent in patients with diagnoses of musculoskeletal and circulatory system diseases and drugs prescription with action on the musculoskeletal, nervous and respiratory system. Drugs that can cause problems not classified as PIME by Beers were prescribed to 25,1 percent of patients. Conclusions The PIME is a frequent problem, it is necessary to adapt and complement the Beers criteria to local situation, and beside to describe the PIME is necessary to study its causes.

Corticosteroid nonprescription use: a cross-sectional hospital-based study in Basrah

To study the prevalence and attitude of using nonprescription corticosteroids [oral or parenteral formulation of glucocorticosteroids] in Basrah, Iraq. A face-to-face model structured interview was used to collect information from 682 patients between January 2006 and December 2008. The following information was obtained: age, gender, marital status, smoking, drinking of alcohol, occupation, educational level, social class and place of residence. Of the 682 [2.6%] subjects using nonprescription corticosteroids most were females: 471 [69%]; married: 567 [83%]; of low social class: 430 [63.1%]; lived in the city center: 475 [69.6%]. The majority [569, 83.5%] thought that corticosteroid use was safe and 463 [68.0%] did not feel guilty for using such medications. About half of them [377, 55.3%] were still using drugs at the time of presentation. Three hundred and fifty-seven [52.4%] reported that physicians advised them for the first time to use corticosteroids and the remaining 325 [42.2%] used it to become beautiful or marry. Three hundred and sixty-four [53.4%] patients obtained the drug from the pharmacy and 252 [36.9%] from street vendors. Weight gain was the main indication for use in 342 [50.1%] patients. Almost all had some features of corticosteroid side effects. This study showed high use of nonprescription corticosteroid in Basrah, Iraqi. We therefore recommend educational programs to alert the population of the untoward side effects of corticosteroids

Tratamientos sustitutivos en enfermedad renal: diálisis peritoneal, hemodiálisis y trasplante renal / Substitute treatment and replacement in chronic kidney disease: peritoneal dialysis, hemodialysis and transplant

Los tratamientos sustitutivos de diálisis crónica o trasplante renal se inician cuando la filtración glomerular del paciente medida por la depuración de creatinina endógena en la orina de 24 horas es inferior a 15 o 10 ml/mm y cuando se presentan complicaciones. A los enfermos con indicaciones de trasplante se les debe buscar un donador vivo seleccionado o inscribirlos en la lista de espera nacional de donación cadavérica si no existen contraindicaciones. Aun cuando no hay un registro nacional mexicano de pacientes en diálisis crónica, solo datos indirectos de la Fundación Mexicana del Riñón y de la industria de diálisis, se estima que de 40 mil a 50 mil son sujetos a este tratamiento y que anualmente la cifra se incrementa 11 %. En términos generales se considera que por cada enfermo en diálisis crónica hay otro que fallece sin acceso al tratamiento. Las unidades de hemodiálisis deben cumplir con la norma oficialmexicana de hemodiálisis y la cédula de evaluación de la calidad de las unidades de hemodiálisis del Consejo de Salubridad General. Es aconsejable que los pacientes sean incorporados a diálisis crónica después de ser presentados al comité de diálisis, y que el tratamiento se aplique con la aceptación del enfermo o sus familiares y se registre en el censo nominal.

Chronic dialysis replacement treatments or renal transplants are instituted when the patient's glomerular filtration rate, measured by 24-h urine endogenous creatinine clearance, is <10-15 ml/mm and, as the The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI), European and Canadian guidelines point out, when one or two of the following complications occur: "uremic toxicity" symptoms, significant fluid retention that does not respond to loop diuretics, hyperkalemia, chronic anemia (hemoglobin <8 g), metabolic acidosis or acute pulmonary edema. In all patients for whom transplant is indicated, a selected live donor must be sought or, in the absence of contraindications, the patient should be registered with the national cadaver donation waiting list. While waiting for the transplant, patients will be on a chronic dialysis program. There is no national registry of patients undergoing chronic dialysis; only indirect data from the Mexican Kidney Foundation and the dialysis industry are available. However, it is estimated that 40,000-50,000 people are under this treatment and the numbers grow by 11% every year. Overall, it is thought that for every patient receiving chronic dialysis, there is one more patient who dies without access to therapy. Hemodialysis units must comply with the Official Hemodialysis Standard and the General Health Council Hemodialysis Unit Quality Assessment Form.

Drug use pattern in children at a teaching hospital.

This study aimed to evaluate drug utilization in pediatric out-patient department of a tertiary care teaching hospital. The patient and drug information of 254 patients was analyzed for WHO recommended prescribing indicators. The average number of drugs per prescription was 2.31 and 45% of medicines were prescribed from National List of Essential Medicines. The use of injectibles was low (1.18%) while an antibiotic was prescribed in 29.1%. Only 5.8% medicines were prescribed by generic name. Interventions are required to improve prescribing by generic name so as to further rationalize drug use in pediatric population.