[Bacteraemia in adult patients discharged from Emergency department]. / Bacteriemia en pacientes adultos dados de alta en el servicio de urgencias.

INTRODUCTION: Bacteraemia is a marker of severity of infectious processes. However, sometimes in Emergency Department blood cultures are drawn from patients who are discharged without results being available. MATERIAL AND METHODS: Prospective study of bacteraemia was conducted on adult patients from Emergency Department of tertiary university hospital from March 2014 to February 2015. Epidemiological, clinical and microbiological data were collected from patients admitted and discharged. After the detection of bacteraemia, the microbiology department telephoned the physician responsible (patients admitted) or Primary Care physician (patients discharged). RESULTS: A total of 429 episodes of bacteraemia were included, of which 13.52% were discharged. These patients were younger (68.5 vs 73.59 years, P=.0001), had a lower Charlson index (1.603 vs 2.309, P=.0013) and lower severity (septic shock 0 vs 34; P<.0001) than admitted patients. After the call to Primary Care, oral antibiotics were started in 10.3%, a change in oral antibiotic in 6.9%, 12% were admitted to hospital, and the rest of them continued same treatment. The 30-day mortality rate was 0%. CONCLUSIONS: There was a significant number of patients with bacteraemia were discharged from Emergency Department. To discharge a clinically stable patient with blood cultures taken in Emergency Department is safe, if there is a re-assessment of the patient if these cultures are positive.

Fractura-avulsión pélvica durante la actividad deportiva / Pelvic avulsion fracture during sports activity

Las fracturas pélvicas por avulsión se producen tras contracciones musculares violentas o explosivas en pacientes con esqueleto inmaduro. Tienen lugar por un desequilibrio entre la fuerza de tracción del músculo o tendón y la resistencia del cartílago apofisario donde se insertan, siendo verdaderos autotraumatismos. Estas lesiones habitualmente tienen un buen pronóstico, mediante un tratamiento conservador. Presentamos el caso clínico de un niño de 13 años que durante una actividad deportiva sufrió dolor e impotencia funcional en el muslo derecho, diagnosticándose de fractura-avulsión de la espina ilíaca anteroinferior derecha. Realizamos un seguimiento clínico y ecográfico; el paciente presentó una correcta evolución con reposo articular y analgesia y pudo reincorporarse a la actividad deportiva a los dos meses de la lesión(AU)

Avulsion fractures occur after violent or explosive muscular contractions in skeletally immature patients. They take place because of an imbalance between the pulling muscle force and the bone resistance where they are inserted. These lesions have a good prognosis with conservative treatment. We report a case of a thirteen year old male patient, who during sports activity referred acute pain and functional disability in the right thigh. An avulsion fracture of the anterior inferior iliac spine was diagnosed. A clinical and ultrasound imaging follow up was made, showing a satisfactory progress with joint rest and conventional analgesia, restoring sports activity two months after the initial injury(AU)

Serotipos de Samonella entérica en productos alimenticios de Zaragoza, comparación con aislamientos clínicos / Salmonella enterica serotypes in Zaragoza foodstuffs, comparation with clinical isolates

Hemos estudiado la evolución de las serotipos de Salmonella enterica en las muestras de productos alimenticios analizados en el Instituto Municipal de Salud Pública de Zaragoza en los últimos 20 años y la hemos comparado con la evolución de los serotipos de Salmonella en coprocultivos de pacientes de un hospital general universitario (Hospital Lozano Blesa) de nuestra ciudad y con los datos publicados en muestras de alimentos de otras regiones españolas. Los serotipos más frecuentes en alimentos en Zaragoza son Typhimurium (30.42%) y Enteritidis (24.51%), con variaciones importantes según grupos de productos y comparables con los datos informados en muestras de alimentos en nuestro entorno. Los serotipos más frecuetes en alimentos de nuestra ciudad, son también los más frecuentes en las muestras clínicas aunque con importantes diferencias porcentuales

We have studied the evolution of Salmonella enterica serotypes in foodstuffs samples analyzed in the Municipal Institute of Public Health of Zaragoza during the las 20 years, and we have compared them with the evolution of the Salmonella serotypes in patients coprocultures ofa university general hospital (Hospital Lozano Blesa) of our city and with the published data about food samples in other Spain regions. Typhimurium (30,42%) and Enteritidis (24.51) are the most frequent serotypes in food samples in Zaragoza, with important variations according to foodstuffs and comparable with the data reported in other Spanish regions. The most frequent serotypes in food of our city, are also the most frequent ones in the clinical samples although with important percentage differences

Femoral head necrosis after intertrochanteric fracture: a case report after synthesis with Ender nails.

A case of femoral head necrosis in a patient who suffered an intertrochanteric fracture, treated with Ender nails 1 year before, is presented. The rarity, and possible mechanisms (reduction and type of osteosinthesis) of necrosis are discussed.

[Blastocystis hominis and abdominal pain in childhood]. / Blastocystis hominis y dolor abdominal en la infancia.

We report the clinical features observed in 10 children, ranging from 5 1/12 to 13 7/12 years of age, with intestinal infections caused by Blastocystis hominis. A parasitological study of the stools was made by using the ethyl-acetate formol concentration technique and a count of the number of B. hominis per field was performed. In 8 of the cases, no other enteropathogens (viruses, bacteria or other parasites) were found, whereas in 2 cases Giardia lamblia was also isolated. Nine out of ten of the patients presented with abdominal pain. In three of the cases it appeared as a pseudo-appendicular ailment which led to an appendectomy. Those children who were treated with metronidazole and those who were not treated with antibiotic recovered satisfactorily.

[Expediency of hospital admission for acute diarrhea syndrome in a short-stay unit]. / Oportunidad de ingreso hospitalario del síndrome de diarrea aguda en una unidad de corta estancia.

We present the results of a 187 cases acute diarrhea study managed in the Short Stay Unit of Clinic Universitary Hospital of Zaragoza during 1987-1988. To that aim, we designed an actuation protocol which included the gathering of several data, the realization of complementary studies and the evolutive pursuit. The coproculture resulted positive in a 54.5% of cases and Salmonella was the microorganism more frequently isolated. Most of the species were sensible to common antibiotics and all of them sensible to norfloxacin. Nearly a third part of patients developed some kind of complication. Therefore we infer that acute diarrhea may be subsidiary of diagnosis and treatment in Short Stay Units.

[Intestinal infections caused by Aeromonas]. / Infecciones intestinales por Aeromonas.

We have identified 38 instances of intestinal infection by Aeromonas and 4 by Plesiomonas in 16,184 coprocultures carried out during a 4 year period in the HCU of Zaragoza. The low prevalence can be related with the fact that specific media for the recovery of these organisms were not used. The species Aeromonas sobria (47.36%) and A. caviae (39.47%) were more common than A. hydrophila (13.15%). Aeromonas were isolated from patients with and without intestinal disease. The occurrence of gastrointestinal disease was independent from the type of Aeromonas species isolated (p greater than 0.1). We did not find significant differences when we compared patients with and without diarrhea, the rates of the strains that produced gas from glucose, and those of the strains that did not produce arabinose acid. The rates of positivity for lysine decarboxylase and Voges-Poskauer were significantly more common in the strains isolated from symptomatic patients. The sensitivity to cephalothin (MIC less than or equal to 8 micrograms/ml) can be an adequate marker to differentiate A. sobria from the other two species (p less than 0.01).