Rabdomiólisis por múltiples picaduras de avispa asiática (Vespa velutina) / Asian black hornet (Vespa velutina) multiple stings and secondary rhabdomyolysis

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[Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases]. / Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos.

INTRODUCTION: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. AIMS: To know the clinical characteristics in the presentation of the lung cancer in our health care area. MATERIAL AND METHODS: All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. RESULTS: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. CONCLUSIONS: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis.

Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos / Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases

Introducción: El cáncer de pulmón es la causa más frecuente de muerte por cáncer en el mundo. Su presentación clínica corresponde habitualmente a estadios avanzados. Desde hace años persiste la controversia sobre la indicación de programas de cribado para el diagnóstico en fases tempranas. Objetivos: Conocer las características clínicas en la presentación del cáncer de pulmón en nuestra área sanitaria. Material y métodos: Se recogieron retrospectivamente todos los casos incidentes de cancer de pulmón durante 3 años (1 de enero de 1997 a 31 de diciembre de 1999), de pacientes con residencia habitual en el área sanitaria de Santiago de Compostela, a partir de la información disponible en el servicio de codificación. El tipo histológico se clasificó según la clasificación de la Organización Mundial de la Salud. La fecha de fallecimiento se obtuvo de la historia clínica del paciente, el registro de mortalidad o de llamadas telefónicas al domicilio del paciente. El resto de la información se obtuvo de la historia clínica del paciente y del servicio de anatomía patológica. Resultados: Se diagnosticaron 481 casos de cáncer de pulmón (tasa bruta de incidencia de 41,79 por 100.000 habitantes y año). La mediana de edad fue 66,9 años (rango intercuartil 60,5-74,4), siendo el 92,77% varones. El 94,1% correspondía a fumadores o exfumadores. Los síntomas más prevalentes como motivo de consulta fueron el síndrome general (20%), el dolor torácico (19%) y la hemoptisis (17%). Existe un grupo de pacientes (56), fundamentalmente varones, de diagnóstico incidental. Conclusiones: La incidencia de cáncer de pulmón parece elevada en nuestra área sanitaria. El paciente tipo con cáncer de pulmón en esta área sanitaria corresponde a un varón de 67 años, fumador, diagnosticado en estadios avanzados, que consulta por síndrome general y/o dolor torácico. Algunos de los síntomas se presentan con diferencias significativas entre sexos. Asimismo, hay diferencias entre histologías, siendo llamativa la elevada frecuencia de dolor torácico en adenocarcinoma, aunque también es la primera causa de consulta en microcítico. Por el contrario, la hemoptisis es el motivo de consulta más frecuente en epidermoide y el síndrome general en el tipo células grandes o con diagnóstico clínico-radiológico (AU)

Introduction: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. Aims: To know the clinical characteristics in the presentation of the lung cancer in our health care area. Material and methods: All of the incident lung cancer cases for 3 years (January l, 1997 to December 3l, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. Results: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. Conclusions: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis (AU)

Cuidados paliativos en pacientes trasplantados de órgano sólido / No disponible

No disponible

Ingresos en HADO desde el Servicio de Urgencias / No disponible

No disponible

[Adequancy of the pharmacological disponibility in a Department of Internal Medicine to the WHO essential drug list]. / Adecuación de la disponibilidad farmacológica en un Servicio de Medicina Interna a la lista de medicamentos esenciales de la OMS.

INTRODUCTION: Since several years ago, the World Health Organization (WHO), publishes the Essential Drug List (EDL) including medicines that are used to cover the mayor health community problems. Drugs are selected in terms of importance, usefulness, safety and cost-effectiveness. There is no enough data about adequacy between this list and the current medical practise in Internal Medicine. MATERIAL AND METHODS: Both EDL (13 edition, reviewed on April 2003) and the list of medicines used in the Internal Medicine Department from the Hospital da Barbanza, Riveira, A Coruña (Spain), Fundación Pública del Servizo Galego de Saúde in 2004-2005 were compared. RESULTS: From the 27 groups included in the EDL, 2 groups were excluded because no regular use in Internal Medicine. Among the other 25 groups there were significant differences in 24 groups. Just in one group both lists were identical. In all the 24 groups with differences, we used an smaller amount of drugs that recommended in the EDL. We analysed 15 groups (the groups with at least 5 differences between both lists). Causes identified were as follows: drugs used in diseases that we used to send to another hospital (Reference Hospital) in groups 6,8 and 12; drugs not commonly prescribed in Internal Medicine in groups 1,4,13,14,18,19 and 21, and finally drugs not currently financed by the National Health System (group 27). CONCLUSIONS: After examining the adequacy of the list of drugs prescribed in Internal Medicine in a Community Hospital we conclude that its use is significantly lower than the standard recommendations derived from de WHO. Identified causes are treatments not covered in a Community Hospital needing to transfer patients to another hospital and the inclusion of drugs not commonly used in Internal Medicine. The WHO estimates that over 2000 million people can not currently access to essential drugs nor vaccines all over the world. The problem is not just a health problem but also a social, economic and ethic one. So, an accurate use of such essential drugs in developed Health Systems could be a good example of efficiency.

Cuidados Paliativos en enfermedades raras: un nuevo desafío / No disponible

No disponible

Adecuación de la disponibilidad farmacológica en un Servicio de Medicina Interna a la lista de medicamentos esenciales de la OMS / Adequacy of the pharmacological disponibility in a department of internal medicine to the who essential drug list

Introducción: Desde hace años la organización mundial de la salud (OMS) elabora una lista de medicamentos esenciales (LME), considerando como tales a los que cubren las necesidades de atención de salud prioritarias de la población. Son seleccionados según su importancia, eficacia, inocuidad y relación costo-eficacia. No existe información suficiente sobre la adecuación de esta lista al uso habitual en la práctica común en Medicina Interna. Material y métodos: Se comparó la LME de la OMS (13ª edición, revisada en abril de 2003) con los utilizados en el Servicio de Medicina Interna del Hospital da Barbanza, Riveira, A Coruña (España), Fundación Pública del Servizo Galego de Saúde en el período 2004-2005. Resultados: De los 27 grupos de la lista de la OMS se excluyeron 2 porque su uso no es habitual en Medicina Interna. De los restantes 25 grupos, se encontraron diferencias en 24 grupos. En 1 grupo ambas listas eran idénticas. En los 24 grupos con diferencias se usaban menos fármacos de los recomendados por la OMS. Se analizaron 11 grupos; aquéllos en los que el número de diferencias era mayor que 5. Las causas resultaron ser: grupos 6,8 y 12, fármacos para pacientes habitualmente remitidos a nuestro hospital de referencia; fármacos no utilizados habitualmente en Medicina Interna (grupos 1,4,13,14,18,19 y 21) y medicamentos que no cubre el Sistema Nacional de Salud (Grupo 27). Conclusiones: La valoración de la adecuación de los fármacos utilizados en Medicina Interna en un Hospital Comarcal muestra un uso significativamente inferior a las recomendaciones estándar de la OMS. Las causas identificadas son terapias no cubiertas por un Centro como el nuestro y aquellos fármacos no utilizados habitualmente en Medicina Interna. La OMS estima que unos 2000 millones de personas no tienen acceso regular a medicamentos esenciales y vacunas de calidad en el mundo. La dimensión del problema trasciende el ámbito de la salud, suponiendo un problema social, económico y ético por lo que el buen uso de los fármacos esenciales en sistemas sanitarios desarrollados es un buen ejemplo de eficiencia

Introduction: Since several years ago, the World Health Organization (WHO), publishes the Essential Drug List (EDL) including medicines that are used to cover the mayor health community problems. Drugs are selected in terms of importance, usefulness, safety and cost-effectiveness. There is no enough data about adequacy between this list and the current medical practise in Internal Medicine. Material and methods: Both EDL (13 edition, reviewed on April 2003) and the list of medicines used in the Internal Medicine Department from the Hospital da Barbanza, Riveira, A Coruña (Spain), Fundación Pública del Servizo Galego de Saúde in 2004-2005 were compared. Results: From the 27 groups included in the EDL, 2 groups were excluded because no regular use in Internal Medicine. Among the other 25 groups there were significant differences in 24 groups. Just in one group both lists were identical. In all the 24 groups with differences, we used an smaller amount of drugs that recommended in the EDL. We analysed 15 groups (the groups with at least 5 differences between both lists). Causes identified were as follows: drugs used in diseases that we used to send to another hospital (Reference Hospital) in groups 6,8 and 12; drugs not commonly prescribed in Internal Medicine in groups 1,4,13,14,18,19 and 21, and finally drugs not currently financed by the National Health System (group 27). Conclusions: After examining the adequacy of the list of drugs prescribed in Internal Medicine in a Community Hospital we conclude that its use is significantly lower than the standard recommendations derived from de WHO. Identified causes are treatments not covered in a Community Hospital needing to transfer patients to another hospital and the inclusion of drugs not commonly used in Internal Medicine. The WHO estimates that over 2000 million people can not currently access to essential drugs nor vaccines all over the world. The problem is not just a health problem but also a social, economic and ethic one. So, an accurate use of such essential drugs in developed Health Systems could be a good example of efficiency

Pneumocystis, continúa la polémica / Pneumocystis, the controvery continues

No disponible

Desgaste profesional en atención continuada del área médica / Burnout in continuing attention of a medical area

No disponible

Absceso pulmonar y piomiositis pectoral por Staphylococcus aureus / Lung abscess and pectoral pyomiositis by Staphylococcus aureus

No disponible

[Vitamin D treatment in childhood: an evidence based discussion]. / Tratamiento con vitamina D en la infancia: discusión de la evidencia.

Vitamin D treatment during childhood has been recommended in those younger than one. Evidence is not available to recommend this treatment in general population. Solar exposure is enough in most infants younger than 1 year, and this should be taken into account. Data showing optimal doses at this stage is not available to date. Our review suggests, solar exposure in Spain appears sufficient.