ABSTRACT
BACKGROUND: Trauma registries (TR) collect information about trauma patients according to inclusion criteria, and it helps to establish protocols to improve care. However, all TR deal with incompleteness. The aim of this study is to assess the number of patients not included despite fulfilling inclusion criteria in our regional TR and identifying the predictors for being missing. METHODS: The sample was randomly selected. Two months of each year from 2010 to 2014 (5 years) were selected, and medical files of all patients attended in the emergency department room during those months were studied. Patients who were already correctly included in the TR were assigned to the 'included' group, and patients who should have been but were not to the 'missing' group. The multivariable logistic regression analysis was performed to identify predictors for being missed from the TR. RESULTS: Of a total of 200, 79 (40 % approximately) were identified as missing. We defined the characteristic profiles of missing patients and found that the hospital RTS and the number of injuries are independent predictors to be missing in our trauma registry, with an adjusted odds ratio of 1844 [95 % (1092-3114) and 0.574 (95 % CI 0.428-0.770)], respectively. CONCLUSIONS: Overall, 40 % of the patients who met the inclusion criteria of the TR were not included in the registry. Our results can be generalized to other trauma records based on Utstein style, because we think probably that this fact is also happening in other databases.
Subject(s)
Databases, Factual/standards , Emergency Medical Services/standards , Registries/standards , Wounds and Injuries/epidemiology , Aged , Benchmarking , Female , Humans , Incidence , Male , Middle Aged , Quality Improvement , Spain/epidemiology , Trauma CentersABSTRACT
La enfermedad de McArdle es una miopatía metabólica que puede implicar graves complicaciones durante el acto anestésico. Exponemos el caso de una paciente sometida a mastectomía, diagnosticada previamente de enfermedad de McArdle. El conocimiento de la fisiopatología y la aplicación de medidas de prevención puede evitar complicaciones de posible desenlace fatal. Se describen las posibles complicaciones y las medidas de prevención y tratamiento (AU)
McArdle disease is a metabolic myopathy that can may lead to severe perioperative problems. A case is reported of a woman with a history of McArdle disease, who was scheduled for a mastectomy. An understanding of the physiology and pathology, and the application of appropriate preventive measures can avoid complications. A overview of the complications and the management are described (AU)
Subject(s)
Humans , Female , Middle Aged , Glycogen Storage Disease Type V/drug therapy , Glycogen Storage Disease Type V/complications , Mastectomy/methods , Midazolam/therapeutic use , Glycogen Storage Disease Type V/prevention & control , Intubation, Intratracheal/instrumentation , Diuresis , Fentanyl/therapeutic use , Propofol/therapeutic use , Albuterol/therapeutic useABSTRACT
McArdle disease is a metabolic myopathy that can may lead to severe perioperative problems. A case is reported of a woman with a history of McArdle disease, who was scheduled for a mastectomy. An understanding of the physiology and pathology, and the application of appropriate preventive measures can avoid complications. A overview of the complications and the management are described.
Subject(s)
Anesthesia, General/methods , Glycogen Storage Disease Type V/physiopathology , Intraoperative Complications/prevention & control , Acute Kidney Injury/etiology , Acute Kidney Injury/prevention & control , Anesthesia, General/adverse effects , Breast Neoplasms/complications , Breast Neoplasms/surgery , Carcinoma/surgery , Female , Glucose/administration & dosage , Glycogen Storage Disease Type V/complications , Humans , Hypoglycemia/etiology , Hypoglycemia/prevention & control , Hypothermia/prevention & control , Malignant Hyperthermia/etiology , Malignant Hyperthermia/prevention & control , Mastectomy, Simple , Middle Aged , Myoglobinuria/etiology , Myoglobinuria/prevention & controlABSTRACT
Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies.
Subject(s)
Neoplasms/epidemiology , Emergencies , Humans , Spain/epidemiologyABSTRACT
Los pacientes oncológicos no representan un gran volumen dentro del global de un servicio de urgencias, pero sus características clínicas hacen que su atención sea a menudo compleja. La realización de una historia clínica completa, en la que se especifiquen las características y estadio de la enfermedad tumoral, es un arma fundamental para la toma de decisiones en el momento urgente. Según datos de nuestro centro, los enfermos oncológicos representan un 5% del total de las urgencias. El tipo de tumor que más frecuentemente atendemos es el pulmonar, seguido del de mama y colon. Es frecuente que estos enfermos acudan a urgencias varias veces en un mismo mes y el motivo de consulta más frecuente es el dolor, aunque es habitual que comenten varias causas en cada ocasión. En un alto porcentaje de casos la causa de su consulta está relacionada con la propia enfermedad pero hasta en un 35% de las ocasiones es una patología intercurrente. El índice de ingresos es elevado (alrededor del 50%) y especialmente si el paciente ha acudido por un motivo relacionado con la enfermedad. En global suponen un 14% del total de ingresos desde urgencias (AU)
Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies (AU)
Subject(s)
Humans , Neoplasms/epidemiology , Emergencies , Spain/epidemiologyABSTRACT
En este texto se analizan dos componentes íntimamente ligados, en el primero los referidos a la doctrina de la salud pública que en la evolución de las sociedades es la aplicación de las ciencias biológicas, sociales, económicas, culturales y políticas. En la segunda parte, se analiza la formación del recurso humano médico
Subject(s)
Education, Medical, Undergraduate , Health Education , Public HealthABSTRACT
En este texto se analizan dos componentes íntimamente ligados, en el primero los referidos a la doctrina de la salud pública que en la evolución de las sociedades es la aplicación de las ciencias biológicas, sociales, económicas, culturales y políticas. En la segunda parte, se analiza la formación del recurso humano médico
Subject(s)
Education, Medical, Undergraduate , Health Education , Public HealthABSTRACT
Esta presente obra es otra vez una ilustración de la labor del autor, la cual enfoca la salud en contradicción con la enfermedad. La promoción de la salud, favorecerá al desarrollo de la creatividad individual y colectiva de toda la nacionalidad, dentro de una satisfacción espiritual, en un clima de paz y armonía
Subject(s)
Public Health , BoliviaABSTRACT
Hasta el año 1890, lo que ahora es el Departamento de Pando, fue una región desconocida para el resto del país y como hasta el presente, sin vías de acceso estables, lo que hace de este girón patrio un emporio de leyenda, donde vivieron muchas tribus de origen amazónico, dentro de sus propios comportamientos culturales, hoy por hoy en periodos de franca transformación, sobre todo por la presión del vecino Brasil, que recurre a todo argumento para su penetración pacífica.
Subject(s)
Male , Female , Humans , Public Health , BoliviaABSTRACT
One hundred and twenty-two patients with confirmed duodenal ulcer were treated with cimetidine during 6 or 12 weeks. After gastroscopic confirmation of healing, treatment was suppressed during 3 months. Patients were randomized into two therapeutic regimens: intermittent according to recurrence of symptoms and maintenance with 400 mg cimetidine. In patients considered as having mild disease (healing at 6 weeks without recurrence) fared better with maintenance therapy than with intermittent dosage. All patients with moderate to severe disease on intermittent therapy had a recurrence (criterion: more than 6 weeks for healing the ulcer or recurrence before three months). Those on maintenance therapy had the following results: no recurrences 28%, one recurrence 56% and more than one 16%. Ninety three patients were followed during one entire year. There was also a statistical difference in the number of severe complications among patients on continuous maintenance (nil) and those on intermittent therapy (8%, p less than 0.05).
Subject(s)
Cimetidine/therapeutic use , Duodenal Ulcer/drug therapy , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Risk FactorsABSTRACT
We performed esophageal manometry on 17 cirrhotic patients (group I) treated with repeated varicose sclerosis (VS) after the varices had been completely eradicated. We used 5% ethanolamine oleate with the free hand technique, administering intra-varix injections at the cardia level, never exceeding 25 cc per session. The first two sessions were spaced a week apart, and the consecutive ones were on a monthly basis. The mean number of VS sessions was 5.52. The esophageal motility study was carried out on the average 12.3 months after the last VS session, with a minimum of six and maximum of 17 months. As controls we used 16 cirrhotic patients with unsclerosed varices (group II) and 26 healthy subjects (group III). The mean age and patient distribution were similar, according to Pugh grading. The length of the lower esophageal sphincter (LES) and the amplitude of the propulsive waves in the middle esophagus were similar in all three groups. We found the LES pressure to be significantly reduced in group I (17.52 +/- 2.8 mmHg) in relation to group II (20.26 +/- 2.49 mmHg) (p less than 0.001) and group III (22.86 +/- 3.73 mmHg) (p less than 0.01). The group II patients showed significantly lower pressure levels than the group III ones (p less than 0.05). The amplitude of peristaltic waves in the distal esophagus was significantly less in group I (22.94 +/- 7.31 mmHg) than in group II (37.46 +/- 10.95 mmHg) (p less than 0.01) and group III (44.8 +/- 11 mmHg) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Esophageal Motility Disorders/etiology , Esophageal and Gastric Varices/therapy , Liver Cirrhosis/complications , Sclerotherapy/adverse effects , Adult , Aged , Esophageal Motility Disorders/physiopathology , Esophageal and Gastric Varices/etiology , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/prevention & control , Humans , Male , Manometry , Middle Aged , Oleic Acids/administration & dosage , Sclerosing Solutions/administration & dosageABSTRACT
122 patients with duodenal ulcus have been treated with a cimetidine's single night dose of 800 mg over 6 or 12 weeks. After this period of time, 18 patients still had their wounds without complete healing. This group of patients had been afterwards treated with a combination of ranitidine and sulfacrate over a six weeks period. Only 3 of them achieved a complete ulcus reepitelization, although all of them were clinically asymptomatic. These 3 patients moved to a nightly maintenance treatment guideline of 150 mg of ranitidine, but they quickly presented relapses. A significantly higher consumption of tobacco and alcohol was observed among the patients who did not heal after 12 weeks of treatment with cimetidine. On the other hand the rest of the general facts and ulcus endoscopic characteristics have been similar both in patients resistant to cimetidine and in those who had a favorable evolution.
