Determinantes del tiempo de espera en urgencias hospitalarias y su relación con la satisfacción del usuario / Determinants of the waiting period at the Hospital Emergency Services and its relation to user satisfaction

Objetivo: Describir los tiempos del proceso de asistencia en Urgencia y contrastar la influencia de los tiempos reales y percibidos en la satisfacción expresada por el paciente. Analizar las variables que pueden influir en los tiempos de espera. Métodos: Estudio epidemiológico transversal descriptivo. Se seleccionaron, de forma sistemática, los pacientes que acudieron al Servicio de Urgencias del Hospital de Elda. Sobre una muestra total de 325 sujetos, y a través de un cuestionario, se obtuvieron datos relativos a descripción sociodemográfica de la población, relación de los tiempos con diferentes variables (información, dolor, gravedad, etc.) y con la satisfacción del paciente. Se estimaron medias, desviación estándar y sucesivos análisis bivariantes mediante SPSS 10.0. Resultados: Se determinó una relación estadísticamente significativa entre la satisfacción del paciente y el tiempo percibido por el mismo con F: 4,84, p<0,029. No hubo una relación significativa entre la información dada al paciente (t:-1,76, p:0,08) o a la familia (t: -0,35, p: 0,73) con la percepción del tiempo transcurrido en Urgencias. Conclusión: Los factores que se relacionaron con un mayor tiempo en Urgencias fueron: mayor edad, mayor gravedad, permanecer en cama, venir acompañado y el tiempo que transcurrió antes de ser valorado por algún sanitario. Se comprobó una relación significativa entre el tiempo total percibido y la satisfacción del mismo que no se observó con el tiempo total real (AU)

Aims: To describe the time periods of the assistential process in the Emergency Service and establish the influence of real and perceived times on patient-expressed satisfaction. To analyse the variables that might influence the waiting period. Methods: Descriptive cross-sectional epidemiologic study. Patients attending the Emergency Service at the Elda Hospital were systematically selected. On a total sample of 325 subjects, and with the help of a questionnarie, data were recorded regarding the socio-demographic description of the population, the relationship between the time periods and a number of variables (information, pain, severity, etc.), and patient satisfaction. The means and standard deviations were calculated, and successive bivariate analyses performed using the SPSS 10.0 software package. Results: A statistically significant correlation was observed between patient satisfaction and patient-perceived time (F: 4.84; p<0.029). There was no significant correlation between the information given to the patient (t: -1.76, P: 0.08) or to the patient’s family (t: -0.35, P: 0.73) and the perception of time elapsed at the Emergency Service. Conclusion: The factors related to a longer waiting time at the Emergency Service were greater age, greater severity, being bedridden, presence of accompanying persons, and time elapsed prior to assessment by health care personnel. There was a significant correlation between the total time perceived and patient satisfaction, by not between the later and the true elapsed time (AU)

Piomiositis en músculo esternocleidomastoideo / Pyomyositis in sternocleidomastoid muscle

No disponible

[Septicemia caused by Vibrio cholerae non-01 in immunocompromised patient]. / Sepsis por Vibrio cholerae no-01 en paciente inmunodeprimida.

We describe the remarkable case of a patient with septicemia caused by Non 0-1 Vibrio Cholerae associated with skin lesion of the lower and upper extremities. This patient suffered from chronic liver disease and a cervix carcinoma in IIIB stage, she had been admitted to the hospital the day before for dicompensated ascites. She received intravenous cefotaxime and had a satisfactory recovery and was completely free of signs and symptoms. We report its epidemiological discovery in inland freshwater and this is the first announced case in Spain with this confirmed environmental isolation and a rare report case in the literature.

Sepsis por Vibrio cholerae no-01 en paciente inmunodeprimida / Septicemia caused by vibrio cholerae non-01 in immunocompromised patient

Describimos el caso poco frecuente de una paciente con una sepsis por Vibrio Cholerae no 0-1 asociado a lesiones cutáneas en extremidades inferiores y superiores. Esta paciente padecía de una hepatopatía crónica y un carcinoma de cérvix en estadío IIIB y había sido ingresada el día previo por una descompensación ascítica. Su evolución fue buena con resolución completa mediante cefotaxima endovenosa. Destacar sobre todo el hallazgo de su origen epidemiológico, aguas continentales de pozos naturales, siendo esta particularidad la que hace de este caso el primero descrito en España con ese origen demostrado y un caso excepcional en la literatura mundial revisada (AU)

[Severe isolated pulmonary hypertension as main manifestation of Crest syndrome]. / Hipertensión pulmonar aislada severa como manifestación principal del síndrome Crest.

Interstitial pulmonary fibrosis is the leading cause of secondary pulmonary hypertension in systemic sclerosis, and it occurs in either limited or diffuse cutaneous scleroderma subset. Isolated pulmonary hypertension, without pulmonary disease, occurs primarily in patients with limited cutaneous scleroderma (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia [CREST] variant) although it is an unusual feature in this subset, with a worse prognosis in the short term. We present a previously undiagnosed patient with the CREST syndrome, with severe isolated pulmonary hypertension and secondary respiratory failure as major feature of its connective tissue disease. Clinical, prognostic and therapeutical aspects are commented.

Hipertensión pulmonar aislada severa como manifestación principal del síndrome Crest / Severe isolated pulmonary hypertension as major feature of the crest syndrome

La fibrosis pulmonar intersticial es la causa más frecuente de hipertensión pulmonar secundaria en la esclerosis sistémica, tanto en el subgrupo de escleroderma cutánea difusa como en el de escleroderma cutánea limitada. La hipertensión pulmonar aislada, no asociada a enfermedad pulmonar, aunque ocurre primariamente en pacientes con escleroderma cutánea limitada y su variante el síndrome CREST (calcinosis, fenómeno de Raynaud, dismotilidad esofágica, esclerodactilia y telangiectasias) constituye un hallazgo infrecuente en este subgrupo, implicando un mal pronóstico a corto plazo. Comunicamos el caso de una paciente con síndrome CREST, no diagnosticada previamente, con hipertensión pulmonar aislada severa e insuficiencia respiratoria secundaria como manifestación principal de su conectivopatía. Se comentan aspectos relacionados con la clínica, pronóstico y manejo terapéutico de estos pacientes (AU)

[Lymphocytic colitis: hypopotassemia as a complication and an association with toxic multinodular goiter]. / Colitis linfocítica: hipopotasemia como complicación y associación con bocio multinodular tóxico.

Lymphocytic colitis is a rare clinicopathologic syndrome, characterized by chronic watery diarrhea, diffuse inflammatory changes in the colonic mucous in spite of normal findings on colonoscopy and marked intraepithelial lymphocytic infiltration on biopsy. Although the physiological mechanism of diarrhea is not clear, patients do not usually present hydroelectrolytic alterations and the results of routine laboratory investigations are usually normal. The association between lymphocytic colitis and thyroid disease, possibly autoimmune, in the form of hypo- or hyperthyroidism is relatively common. We report a 61-year-old woman with a history of multinodular toxic goiter, whose previously uninvestigated chronic diarrhea became more acute and led to the diagnosis of lymphocytic colitis. Results of laboratory investigations revealed only a significant hypokalemia with an associated nonfunctioning bilateral adrenal incidentaloma. The patient evolved well when treated with sulfasalazine. Hypokalemia as a complication of lymphocytic colitis and an association between lymphocytic colitis and toxic multinodular goiter does not seem to have been previously described.