Estudio descriptivo de un servicio de atención domiciliaria continuada realizada desde urgencias / 24-hour home emergency call service organized by a hospital emergency department: a descriptive study

Objective: Hospital General de Granollers attends emergencies in patients’ homes on a continuous basis. We studied the types of emergencies attended and, secondarily, the response time, percentage of patients referred to the hospital emergency service, and the number of problems or conflicts that arose. Methods: Prospective study from January through December 2008 to determine the number of calls and their characteristics. Results: In 2008 the hospital’s home emergency service attended 1131 calls (mean 3.09/d). On 121 days analyzed in detail, 359 home emergencies were attended (31.7% of the annual total; mean, 2.97/d). The patients were female in65.7% of the cases. The mean age of the patients was 67.73 years, with ages distributed as follows: < 20 years, 1.1%;20-39 years, 15.3%; 40-59 years, 13.6%; 60-79 years, 29%; and >80 years, 40.9%. Infections were the reason for 37,9%of the calls, followed by trauma (10.31%) and gastrointestinal complaints (9.5%). The most frequent diagnosis was upper airway infection (12%). Ambulances took the patient to the hospital emergency service in 5% of the cases. Few problems arose: 6 were related to finding the address and 1 involved verbal attacks. Conclusions: Most of the emergency patients attended at home were women. Patients over 80 years old made up the largest age group. Infections were the most frequent reason for home emergency service attendance and the medical problems were not serious. Problems and conflicts were rare (AU)

Objetivo: El Hospital General de Granollers (HGG) realiza la atención domiciliaria urgente(ADU) en horario de atención continuada. Se ideó un estudio para conocer la patología atendida. Se valoró como objetivo secundario el tiempo de respuesta de la asistencia, el porcentaje de derivaciones a urgencias y la existencia de situaciones conflictivas. Método: Estudio prospectivo de enero a diciembre de 2008 para determinar el número de visitas y sus características. Resultados: En 2008 el servicio de ADU del HGG realizó 1.131 visitas (media 3,09 visitas/día). Se analizaron 121 días de guardia durante los cuales se realizaron 359 visitas(31,7% del total), media 2,97 visitas/día. El 65,7% fueron mujeres. La edad media fue67,7 años. La distribución por edades: < 20 años 1,1%, 20-39 años 15,3%, 40-59 años13,6%, 60-79 años 29%, > 80 años 40,95%. El 37,9% de la patología fue de causa infecciosa, seguida de traumatología 10,31% y gastroenterología 9,5%. El diagnóstico más frecuente fue el catarro de vías altas (12%). Se derivaron a urgencias en ambulancia el 5% de las visitas. Se recogieron pocas incidencias, 6 casos relacionados con la localización del domicilio y 1 agresión verbal. Conclusiones: La mayoría de los pacientes atendidos fueron mujeres y por edad el grupo más frecuente lo representaron los mayores de 80 años. La patología más atendida fue la de causa infecciosa y por problemas de escasa gravedad. La existencia de situaciones conflictivas fue excepcional (AU)

Tuberculosis de colon: dificultades diagnósticas actuales / Tuberculosis of the conjunctiva

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[Inclusion-body myositis: a familial report of 3 cases]. / Miositis con cuerpos de inclusión: presentación familiar de tres casos.

Inclusion body myositis (IBM) is a myopathy classified until now within the group of idiopathic inflammatory myopathies (IIM). Nevertheless, its clinical and histological features are specific and different from the other IIM. It is refractory to corticosteroid therapy. Recently, a few cases of IBM with familial transmission have been described, which is the first report in our country; previous reported cases in literature are reviewed. The similarities of some forms of IBM with muscle dystrophies, rather than with inflammatory myopathies are discussed.

[Myopathy and polyneuropathy caused by colchicine]. / Miopatía y polineuropatía por colquicina.

A forty-six year old man with chronic renal failure and a toxic chronic liver disease developed progressive muscle weakness after a long trial with colchicine. Physical exam revealed muscle weakness and proximal muscle atrophy with hyporeflexia. Serum levels of creatine kinase were high and signs of myopathy and axonal and demyelinating polyneuropathy was evidenced in electrophysiological studies. Muscle biopsy disclosed a vacuolar myopathy, disruption of myofibers and dilatation of sarcoplasmic reticulum. The clinical pictures was attributed to a toxic myopathy and polyneuropathy due to colchicine, thus this treatment was discontinued. Four week later, the patient was symptom free, the levels of seric creatine kinase were normal and a new muscle biopsy was normal, with disappearance of previous histological findings.

[Evolution of the emergency consultations in patients with human immunodeficiency virus infection in various levels of medical care in an urban area of Barcelona]. / Evolución de las consultas urgentes realizadas por pacientes con infección por virus de la inmunodeficiencia humana en distintos niveles de la atención médica en un área urbana de Barcelona.

Medical emergencies involving patients with Human Immunodeficiency Virus (HIV) infection comprise an increasing number of the total hospitalary consults and contribute to their overflow. In order to evaluate possible alternative solutions to this problem, we performed a retrospective study of urgent medical consults by HIV patients at three different levels of medical care (primary assistance, extrahospitalary and hospitalary emergencies centers) all included in the same urban area of Barcelona. We demonstrated a growing excess in hospitalary emergencies, with high requirements of complementary explorations and hospitalary admittances. In the extrahospitalary emergency center, we can observe a progressive increasing of emergency consults, but still reasonable in number and adequate to the real possibilities of the center. At primary care level, HIV patients consulted because of less severe reasons. We conclude that a possible solution in order to decrease the assistance requirements in the hospitalary emergencies level could be to try to attend these patients in emergency extrahospitalary centers. These centers should be technically provided and with a close relationship both with the primary assistance care level and with the reference hospital.

[Thyrotoxic hypokalemic periodic paralysis]. / Parálisis periódica tireotóxica normocaliémica.

A case of palsy without family history associated to hyperthyroidism, is described. This is an rare entity in our environment (only two cases have been previously described) and may develop with hypo, normo or hyperkalemia. Its potential pathogenicity is discussed, which finally results in a disorder of the ionic interchange at the level of the muscle membrane. The need to identify these secondary forms of recurrent palsy is stressed, given that it may benefit from an adequate treatment. In the case presented here, the normalization of the thyroid function was followed by the sustained elimination of the muscle symptomatology.

[Hypoglycemia: a prospective study in an emergency service]. / Hipoglucemia: estudio prospectivo en un servicio de urgencias.

Hypoglycemia is a frequent clinical situation of particular interest in an emergency department because of its potential gravity and the need for quick and effective treatment. We present a prospective study of 50 patients with hypoglycemia detected in the emergency department. These being 0.17% of all the consultations in this period. The administration of an incorrect doses of insulin was the most frequent cause of hypoglycemia. We observed a good correlation between the BM-test and posterior glycemia. The patients who had initial neurologic symptoms had the lowest levels of glycemia, required more time for recovering and needed more glucose. 20 patients had high levels of glycemia 11.14 mmol/L. This fact was correlated with the amount of glucose administered. The authors suggest 50 g of glucose as the limit for administration, with the possible exception of patients with neurological symptoms.