Factores asociados a reconsultas a urgencias en pacientes frágiles con diabetes tipo 2 que consultan por hipoglucemia / Risk factors associated with emergency service re-visits in frailty diabetic patients who consult for hypoglycaemia

Introducción y objetivos: Las consultas a los servicios de urgencias (SU) por hipoglucemias son un fenómeno frecuente en los pacientes de edad avanzada. El objetivo del presente estudio es evaluar los factores de riesgo asociados a reconsultas a 90días en los pacientes frágiles que consultan al SU por episodios de hipoglucemia. Material y métodos: Estudio observacional retrospectivo. Se incluyeron pacientes >65años atendidos en un área de fragilidad del SU por hipoglucemias relacionadas con el uso de antidiabéticos orales y/o insulinas. Para evaluar los factores de riesgo asociados a reconsultas a los 90días se realizó un análisis multivariante mediante regresión logística, incluyendo las variables relacionadas con la comorbilidad y el tratamiento antidiabético con un valor de p<0,2 en el análisis univariante previo. Resultados: Se incluyeron 106 pacientes. El valor de %HbA1c estuvo disponible en 87 (82,1%) pacientes, de los cuales 10 (11,5%) presentaban una HbA1c ≤5,5%. Al alta, el tratamiento antidiabético se modificó a 63 (59,4%) pacientes. Reconsultaron a urgencias 38 (36,1%) pacientes, 9 (8,5%) de ellos por motivos relacionados con nuevas alteraciones de la glucemia. Los factores que se asocian a reconsultas a los 90días fueron: ser hombre (OR: 3,62 [IC95%: 1,24-10,51]), la modificación del tratamiento al alta (OR: 0,31 [0,11-0,91]) y presentar un valor de HbA1c ≤5,5% (OR: 5,33 [1,16-14,51]). Conclusiones: Los pacientes frágiles con diabetes que consultan al SU por hipoglucemia presentan con frecuencia cifras de HbA1c inferiores a las recomendadas, hecho que se asocia a un aumento en el riesgo de reconsulta a 90días (AU)

Introduction and objectives: Emergency department (ED) visits due to hypoglycaemia are frequent in elderly patients. The main objective of the study is to evaluate the risk factors associated to ED re-visits at 90days in elderly patients who visited ED with an episode of hypoglycaemia. Material and methods: A retrospective observational study was designed, including elderly diabetic patients (>65years) attended in a fragility area of an ED for an episode of hypoglycaemia. To evaluate the risk factors associated to ED re-visits at 90days a multivariate analysis with logistic regression was performed, including those variables related to comorbidity and antidiabetic treatment with a P<0.2 in a previous univariate analysis. Results: 106 patients were included. %HbA1c value was available in 87 (82.1%) patients. Ten (11.5%) patients presented a value of HbA1c ≤5.5%. Antidiabetic treatment was changed to 63 (59.4%) patients at discharge. Thirty-eight (36.1%) patients re-visited the ED at 90days, 9 for glycaemic alterations. The risk factors associated to 90days ED re-visit were: being man (OR: 3.62 [95%CI: 1.24-10.51)), treatment modified at discharge (OR: 0.31 [0.11-0.91]) and to present an HbA1c value ≤5.5% (OR: 5.33 [1.16-14.51]). Conclusions: Fragile patients with diabetes who visit ED for hypoglycaemia present, in high frequency, HbA1c values lower than those recommended, being associated to an increase of ED re-visit risk at 90days (AU)

[Risk factors associated with emergency service re-visits in frailty diabetic patients who consult for hypoglycaemia]. / Factores asociados a reconsultas a urgencias en pacientes frágiles con diabetes tipo 2 que consultan por hipoglucemia.

INTRODUCTION AND OBJECTIVES: Emergency department (ED) visits due to hypoglycaemia are frequent in elderly patients. The main objective of the study is to evaluate the risk factors associated to ED re-visits at 90days in elderly patients who visited ED with an episode of hypoglycaemia. MATERIAL AND METHODS: A retrospective observational study was designed, including elderly diabetic patients (>65years) attended in a fragility area of an ED for an episode of hypoglycaemia. To evaluate the risk factors associated to ED re-visits at 90days a multivariate analysis with logistic regression was performed, including those variables related to comorbidity and antidiabetic treatment with a P<0.2 in a previous univariate analysis. RESULTS: 106 patients were included. %HbA1c value was available in 87 (82.1%) patients. Ten (11.5%) patients presented a value of HbA1c ≤5.5%. Antidiabetic treatment was changed to 63 (59.4%) patients at discharge. Thirty-eight (36.1%) patients re-visited the ED at 90days, 9 for glycaemic alterations. The risk factors associated to 90days ED re-visit were: being man (OR: 3.62 [95%CI: 1.24-10.51)), treatment modified at discharge (OR: 0.31 [0.11-0.91]) and to present an HbA1c value ≤5.5% (OR: 5.33 [1.16-14.51]). CONCLUSIONS: Fragile patients with diabetes who visit ED for hypoglycaemia present, in high frequency, HbA1c values lower than those recommended, being associated to an increase of ED re-visit risk at 90days.

[Hypersensitivity reaction to etoposide. A case report]. / Reacción de hipersensibilidad a etopósido. A propósito de un caso.

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[Pharmacokinetics of vancomycin in neonates of postconceptional age less than or equal to 32 weeks]. / Comportamiento farmacocinético de la vancomicina en neonatos de edad postconcepcional < or = 32 semanas. Propuesta de una pauta de dosificación.

The objective of the present study was to analyze the pharmacokinetic behavior of vancomycin in neonates of postconceptional age < or = 32 weeks (n = 44). The elimination of the antibiotic was influenced by the concomitant treatment with indomethacin and mechanical ventilation. Close monitoring of renal function of the neonate and vancomycin dosage individualization are mandatory when the above factors are present. Vancomycin dosage guidelines have been determined according to serum creatinine of these premature patients.

[Subcutaneous adrenaline versus inhaled salbutamol in the treatment of childhood asthmatic crisis]. / Adrenalina subcutánea versus salbutamol inhalado en el tratamiento de la crisis asmática infantil.

As a bronchodilator, inhaled salbutamol has been shown to be as pharmacologically effective as epinephrine. However the use of the pressurised aerosol is difficult for pediatric patients (mainly under the age of six). The use of spacers (inhalation chambers) could solve this problem. This study was undertaken to compare the clinical effectiveness and toxicity of these two drugs and to try to establish dosage schedules of inhaled salbutamol with spacer in the treatment of acute asthma. The study population consisted of 100 children who were admitted to the emergency room at our hospital with acute asthma. One group receives 0.01 mg/kg of epinephrine (A) (maximum 0.3 mg), the other two groups received inhaled salbutamol (S-1 = 4 puffs and S-2 = 7 puffs) in a period of 20 minutes. Clinical effectiveness was measured by the score of Wood-Downes at 0, 30 and 60 minutes; and no statistical differences were observed between the three groups. The clinical effectiveness was similar in the three groups and the side effects (especially the increase of heart rate) was higher in epinephrine group. Inhaled salbutamol is as effective as subcutaneous epinephrine in management of children in acute bronchoconstricting episodes with less side effects.