Osteal complications as first manifestation in a patient with primary Sjögren's Syndrome and with associated distal tubular acidosis (type 1) and chronic renal insufficiency.

Renal affection is among the complications associated with the Sjögren's Syndrome. Tubulo-interstitial nephritis constitutes the most frequent renal lesion and distal tubular acidosis (Type 1) is the most important clinical manifestation of this tubular dysfunction, although the occurrence of chronic renal insufficiency is not an uncommon finding in the presence of distal renal tubular acidosis. Osteomalacia is a clinical consequence of tubular acidosis caused by buffering of H+ in the bone. We present the case of a woman with osteal complication a year before being diagnosed with primary Sjögren's Syndrome and with distal tubular acidosis and renal insufficiency associated at diagnosis.

[Study of the derivations to an external consultation of Internal Medicine: can be managed the waiting list?]. / Estudio de las derivaciones a una consulta externa de Medicina Interna: se puede gestionar la lista de espera?

BACKGROUND: The lack of coordination and organization between primary and specialized attention, generates inefficiency bags in the area of external consultations. MATERIAL AND METHOD: The characteristics of the attention of 120 patients derived consecutively to an external Internal Medicine consultation of a local hospital are analyzed. RESULTS: Of the 120 mentioned patients 19 did not appear (16.23%). 70.3% of the taken care of patients came from primary attention and 29.7% did it of specialized attention. Of the patients derived by primary attention: 63.3% went without data adapted in the derivation leaf, 59.2% did not contribute complementary diagnostic tests and 40.8% were registered in the first consultation. Of the patients derived from specialized attention: 100% contribute clinical information to the consultation, 90% contribute complementary studies and 56.65% are registered in the first consultation. CONCLUSIONS: The discontinuity in the attention between primary and specialized attention generates an inefficient use of the resources, that in the area of external consultations influences in the appearance of waiting lists.

Estudio de las derivaciones a una consulta externa de Medicina Interna: ¿se puede gestionar la lista de espera? / Study of the derivations to an external consultation of internal medicine: can be managed the waiting list?

Fundamento: La falta de coordinación y organización entre atención primaria y especializada, genera bolsas de ineficiencia en el área de consultas externas. Material y método: Se analizan las características de la atención de 120 pacientes citados consecutivamente en una consulta externa de Medicina Interna de un hospital comarcal. Resultados: De los 120 pacientes citados no comparecieron 19 (16,23 por ciento). El 70,3 por ciento de los pacientes atendidos procedían de atención primaria y el 29,7 por ciento lo hacían de atención especializada. De los pacientes derivados por atención primaria: el 63,3 por ciento acudieron sin datos adecuados en la hoja de derivación, el 59,2 por ciento no aportaba pruebas diagnósticas complementarias y el 40,8 por ciento fue dado de alta en la primera consulta. De los pacientes derivados de atención especializada: el 100 por ciento aporta información clínica a la consulta, el 90 por ciento aporta estudios complementarios y el 56,65 por ciento es dado de alta en la primera consulta. Conclusiones: La discontinuidad en la atención entre atención primaria y especializada genera una ineficiente utilización de los recursos, que en el área de consultas externas influye en la aparición de listas de espera (AU)

[Community acquired pneumonia requiring admission to hospital. Etiology and follow-up of 366 cases]. / Neumonía adquirida en la comunidad que requiere ingreso hospitalario. Aspectos etiológicos y evolutivos entre 366 casos.

UNLABELLED: An eighteen-month prospective study designed to determine the incidence, etiology and prognosis of community acquired pneumonia (CAP) in adults requiring admission to hospital. METHODS: We studied 366 patients admitted to hospital after being diagnosed of CAP at the Emergency Room of a General Hospital. Standard laboratory methods were used for culture from blood and sputum, and serology tests for Legionella pneumophila. Mycoplasma pneumoniae, Chlamydia psittaci and Coxiella burnetti. Patients were evaluated until complete recovery, paying special attention to prognostic factors predictive of death. RESULTS: An etiological diagnosis was established in 99 patients (27.6%). Legionella pneumophila was the most common pathogen accounting for 30 cases (8.2%), followed by Streptococcus pneumoniae with 26 cases. 26 patients died (mortality rate of 7%); factors predictive of death included pre-existing disease, tachypnea and elevated blood urea nitrogen level. CONCLUSIONS: CAP represented 4.4% of admissions. Legionella pneumophila was the most frequently identified pathogen. If tachypnea and/or uremia are noted on admission, there is an increase in the risk of death.