Protocol for assessing mortality reduction with the early use of noninvasive ventilation in prehospital emergency services: A multicentre, observational cohort study in Madrid, Spain.

BACKGROUND: Acute respiratory failure (ARF) has become one of the most prevalent serious pathologies encountered in the emergency medical service (EMS). In hospital settings, noninvasive ventilation (NIV) therapy prevents complications from more aggressive treatments for that condition. However, the scarce evidence on the benefits of NIV in prehospital EMS (i.e., during transport to the hospital) is inconclusive. OBJECTIVES: To determine whether the administration of NIV during prehospital EMS in cases of ARF reduces in-hospital mortality compared with starting NIV on arrival to in-patient EMS. METHODS: This is a multicentre, observational, prospective cohort study. We recruited a total of 317 patients from the Madrid region (Spain) who were prescribed NIV for their ARF using a nonprobabilistic consecutive sampling method. Analyses of the main outcome (in-hospital mortality) and secondary outcomes (length of hospital stay, readmissions, percentage of intensive care unit admissions, and cost-effectiveness) will include descriptive analyses of patients' characteristics, as well as bivariate and multivariate analyses and cost-effectiveness analysis. DISCUSSION: This study will provide data on NIV management in prehospital and in-patient EMS in patients with ARF. Results will contribute to the existing evidence on the benefits of NIV in the context of prehospital EMS while underlining the importance of a standardized formal training for physicians and nurses working in prehospital and in-patient EMSs. CONCLUSION: The VentilaMadrid study will provide valuable data on the clinical factors of patients receiving NIV in prehospital EMS. Further, were our hypothesis to be confirmed, our results would strongly suggest that the administration of NIV in prehospital EMS by medical and nursing profesionals formally trained in the technique reduces mortality and improves prognoses.

Cistinuria: la recurrencia de lo excepcional / Cystinuria: the recurrence of the exceptional

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Anemia como causa de ángor hemodinámico en el paciente con cardiopatía isquémica crónica / Anaemia as a cause of haemodynamic angina in a patient with chronic ischaemic heart disease

La cardiopatía isquémica es la primera causa de mortalidad y una de las primeras de morbilidad en España. La variabilidad de la presentación clínica de esta entidad, tanto en el ámbito de la atención primaria como en servicios de urgencias, requiere una detenida anamnesis y una exhaustiva exploración física. En el caso que presentamos, el ángor y la disnea como síntoma principal referido en la anamnesis y la palidez obvia en la exploración física han sido datos clave para identificar el ángor y la disnea como síntomas de hipoperfusión miocárdica secundaria a anemia (AU)

Ischaemic heart disease is the leading cause of mortality and morbidity and one of the primary causes of morbidity in Spain. The variability in the clinical presentation of this condition at both primary care and emergency services level requires a careful history and a thorough physical examination. In the case presented, the main symptoms of angina and dyspnea reported in the anamnesis, and the obvious pallor in the physical examination, were the key data to identify anaemia as a cause of angina (AU)

[Anaemia as a cause of haemodynamic angina in a patient with chronic ischaemic heart disease]. / Anemia como causa de ángor hemodinámico en el paciente con cardiopatía isquémica crónica.

Ischaemic heart disease is the leading cause of mortality and morbidity and one of the primary causes of morbidity in Spain. The variability in the clinical presentation of this condition at both primary care and emergency services level requires a careful history and a thorough physical examination. In the case presented, the main symptoms of angina and dyspnea reported in the anamnesis, and the obvious pallor in the physical examination, were the key data to identify anaemia as a cause of angina.

[Epilepsy in the temporal lobe: déjà vu in Primary Care]. / Epilepsia del lóbulo temporal: déjà vu en atención primaria.

Epilepsy is a common disease in the general population. 10% of the population will present a seizure throughout his life, although only 1% will have an epileptic condition. We can divide the generalized epilepsy and focal. Es in the latter that more diagnostic and management difficulties may arise in clinical practice, for its wide variety of symptoms and their identification difficult. These symptoms may be referred to differently by each patient, often dismissively. In focal epilepsy, the most prevalent epilepsy that originates in the temporal lobe. The identification and study of this pathology is very important because the patient may have episodes of disconnecting means and in one third of cases secondarily generalized crises. Although most patients the culprit lesion is mesial temporal sclerosis, one must rule out other causes such as tumors or infections.

Epilepsia del lóbulo temporal: déjà vu en atención primaria / Epilepsy in the temporal lobe: déjà vu in Primary Care

La epilepsia es una enfermedad frecuente en la población general. Un 10% de la población va a presentar una crisis epiléptica a lo largo de su vida, aunque tan solo un 1% presentará una enfermedad epiléptica. Podemos dividir la epilepsia en generalizada y en focal. Es en esta última la que mayores dificultades diagnósticas y de manejo puede plantear en la práctica clínica, por su gran variedad de síntomas y su difícil identificación. Estos síntomas pueden ser referidos de una manera distinta por cada paciente, restándole importancia en muchas ocasiones. Dentro de la epilepsia focal, la más prevalente es la epilepsia que se origina en el lóbulo temporal. La identificación y el estudio de esta enfermedad es muy importante, ya que el paciente puede sufrir episodios de desconexión del medio y en un tercio de los casos crisis secundariamente generalizadas. Aunque en la mayor parte de los pacientes la lesión causante es la esclerosis mesial temporal, hay que descartar otras causas, como neoplasias o infecciones (AU)

Epilepsy is a common disease in the general population. 10% of the population will present a seizure throughout his life, although only 1% will have an epileptic condition. We can divide the generalized epilepsy and focal. Es in the latter that more diagnostic and management difficulties may arise in clinical practice, for its wide variety of symptoms and their identification difficult. These symptoms may be referred to differently by each patient, often dismissively. In focal epilepsy, the most prevalent epilepsy that originates in the temporal lobe. The identification and study of this pathology is very important because the patient may have episodes of disconnecting means and in one third of cases secondarily generalized crises. Although most patients the culprit lesion is mesial temporal sclerosis, one must rule out other causes such as tumors or infections (AU)

Manifestaciones neurológicas por déficit aislado de vitamina B12 / Neurological signs due to isolated vitamin B12 deficiency

El déficit aislado de vitamina B12 es una entidad propia de pacientes de edad avanzada y poco común en pacientes menores de 30 años, siendo la edad promedio entre los 60 y 70 años. Esto es debido a que la cobalamina de los alimentos que se separa de las enzimas de la carne por el ácido clorhídrico y la pepsina en el estómago, no se libera sobre todo en los pacientes ancianos, frecuentemente a causa de la aclorhidria. Por ello, el organismo es incapaz de liberar la cobalamina pero sí conserva la capacidad de absorber la vitamina B12 cristalina, que se encuentra en los preparados polivitamínicos. Otra causa son los fármacos que suprimen la producción de ácido gástrico. Las manifestaciones neurológicas del déficit de vitamina B12 pueden aparecer en pacientes con un hematocrito e índices eritrocitarios normales. Incluyen parestesias, pérdida de sensibilidad, fuerza en las extremidades y ataxia. Los reflejos pueden estar atenuados o exaltados. Los signos de Romberg y Babinsky pueden ser positivos, y con frecuencia disminuye la sensibilidad vibratoria y de posición. Los trastornos del comportamiento varían desde irritabilidad y pérdida de memoria hasta una demencia intensa. Es frecuente que estas manifestaciones no remitan completamente con el tratamiento Presentamos un caso de déficit aislado de vitamina 12 en una paciente de 27 años, que acudió a la consulta de Atención Primaria refiriendo, durante la anamnesis, lumbalgia y a la que le atribuye la pérdida de fuerza y sensibilidad que padecía, en hemicuerpo derecho de aparición lenta y progresiva acompañada de cefalea de 4 días de evolución (AU)

Isolated vitamin B12 deficiency is a common condition in elderly patients but uncommon in patients younger than 30 years, with an average age of onset between 60 and 70 years. This is because the dietary cobalamin, which is normally split by enzymes in meat in the presence of hydrochloric acid and pepsin in the stomach, is not released in the stomachs of elderly patients, usually due to achlorhydria. Although the body may be unable to release cobalamin it does retain the ability to absorb vitamin B12 in its crystalline form, which is present in multivitamin preparations. Other causes are due to drugs that suppress gastric acid production. Neurological signs of vitamin B12 deficiency can occur in patients with a normal haematocrit and red cell indices. They include paresthesia, loss of sensation and strength in the limbs, and ataxia. Reflexes may be slowed down or increased. Romberg and Babinsky signs may be positive, and vibration and position sensitivity often decreases. Behavoural disorders range from irritability and memory loss to severe dementia. The symptoms often do not fully respond to treatment. A case is presented of an isolated vitamin B12 deficiency in 27 year-old female patient who was seen in primary health care. During anamnesis she mentioned low back pain, to which she attributed the loss of strength and tenderness in the right side of the body, as well as the slow and progressive onset of accompanied headache for the previous 4 days (AU)

[Neurological signs due to isolated vitamin B12 deficiency]. / Manifestaciones neurológicas por déficit aislado de vitamina B12.

Isolated vitamin B12 deficiency is a common condition in elderly patients but uncommon in patients younger than 30 years, with an average age of onset between 60 and 70 years. This is because the dietary cobalamin, which is normally split by enzymes in meat in the presence of hydrochloric acid and pepsin in the stomach, is not released in the stomachs of elderly patients, usually due to achlorhydria. Although the body may be unable to release cobalamin it does retain the ability to absorb vitamin B12 in its crystalline form, which is present in multivitamin preparations. Other causes are due to drugs that suppress gastric acid production. Neurological signs of vitamin B12 deficiency can occur in patients with a normal haematocrit and red cell indices. They include paresthesia, loss of sensation and strength in the limbs, and ataxia. Reflexes may be slowed down or increased. Romberg and Babinsky signs may be positive, and vibration and position sensitivity often decreases. Behavoural disorders range from irritability and memory loss to severe dementia. The symptoms often do not fully respond to treatment. A case is presented of an isolated vitamin B12 deficiency in 27 year-old female patient who was seen in primary health care. During anamnesis she mentioned low back pain, to which she attributed the loss of strength and tenderness in the right side of the body, as well as the slow and progressive onset of accompanied headache for the previous 4 days.