A comparative cost analysis between two quick diagnosis units of different levels of complexity.

Aim: To compare by micro-costing the costs incurred by quick diagnosis units of tertiary and second-level hospitals. Patients & methods: We included 407 patients from a tertiary and secondary hospital unit. A bottom-up approach was applied. Results: Cost per patient was €577.5 ± 219.6 in the tertiary versus €394.7 ± 92.58 in the secondary unit (p = 0.0559). Mean number of visits and ratio of successive/first visits were significantly higher in the former (3.098 and 2.07 vs 2.123 and 1.12, respectively). Personnel and indirect costs including their percent contribution to overall costs accounted for the main differences. Conclusion: A greater volume of appointments, number of staff and staff time and a greater complexity of patients from the tertiary hospital unit justified the differences in cost outcomes.

A comprehensive evaluation of the gastrointestinal tract in iron-deficiency anemia with predefined hemoglobin below 9mg/dL: A prospective cohort study.

BACKGROUND: Anemia is defined as hemoglobin below the cutoff of normal in studies examining the gastrointestinal (GI) tract in iron-deficiency anemia (IDA). Although the risk of GI cancer (GIC) increases as hemoglobin decreases, guidelines do not usually recommend hemoglobin thresholds for IDA investigation. METHODS: To elucidate whether underlying GI disorders explain the different hemoglobin values and clinical outcomes observed initially in IDA patients referred for GI workup, we prospectively investigated the diagnostic yield of a thorough GI examination in consecutive IDA adults with predefined hemoglobin <9g/dL and no extraintestinal bleeding. RESULTS: 4552 patients were enrolled over 10 years. 96% of 4038 GI lesions were consistent with occult bleeding disorders and 4% with non-bleeding disorders. Predominant bleeding disorders included upper GI ulcerative/erosive lesions (51%), GIC (15%), and angiodysplasias (12%). Diffuse angiodysplasias (45% of angiodysplasias) and GIC showed the lowest hemoglobin values (6.3 [1.5] and 6.4 [1.3]g/dL, respectively). While the spread (diffuse vs. localized) and number (<3 vs. ≥3) of angiodysplasias correlated with the degree of anemia, hemoglobin values were lower in GIC with vs. without ulcerated/friable lesions (6.0 [1.1] vs. 7.0 [1.2]g/dL, P<0.001). CONCLUSION: Not only GIC but also diffuse angiodysplasias caused the most severe anemia in IDA with predefined hemoglobin values <9g/dL.

Varón de 33 años con poliartritis recurrente / A 33-year-old man with recurrent polyarthritis

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[Multiple chemical sensitivity: study of 52 cases]. / Sensibilidad química múltiple: análisis de 52 casos.

BACKGROUND AND OBJECTIVE: Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to various environmental chemicals. The objective of this study was to describe patients with MCS seen in our hospital. PATIENTS AND METHOD: Patients consecutively seen by the Toxicology and Chronic Fatigue Units who presented symptoms of MCS were included. The diagnosis was clinical. All patients completed the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. RESULTS: Fifty-two patients were included. The average age (standard deviation) was 47.2 (7.6) years, and 46 (88%) were females. The origin of the syndrome was related to occupational exposure to various chemical agents in 31 cases (59.6%), including occupational accidents in 14 patients (fumigation of the workplace with insecticides). In 20 patients (38.5%), the syndrome could not be associated with any toxic exposure and was considered a manifestation of chronic fatigue syndrome. The QEESI showed mean scores of 72.9 (18.6) on the chemical inhalant intolerance scale, 45.5 (20.6) on the other intolerances scale, 69.8 (20.6) on the symptom severity scale, 4.4 (1.8) on the masking index and 66.6 (21.7) on the life impact scale. All patients were followed up for a minimum of 12 months, and during this period they remained stable with no deaths. CONCLUSIONS: MCS normally affects middle-aged women. It is frequently triggered by exposure to chemical agents, especially insecticides. An association with chronic fatigue syndrome is common. The prognosis is good but the patients' quality of life is seriously affected.

Sensibilidad química múltiple: análisis de 52 casos / Multiple chemical sensitivity: study of 52 cases

Fundamento y objetivo: La sensibilidad química múltiple (SQM) se caracteriza por la pérdida de tolerancia a la presencia en el medio ambiente de agentes químicos diversos. El objetivo de este trabajo es describir las características clínicas de una serie de pacientes con SQM atendidos en nuestro hospital. Pacientes y método: Se ha evaluado a los pacientes atendidos en las Unidades de Toxicología y de Fatiga Crónica que presentaban síntomas de SQM. El diagnóstico fue clínico. Todos ellos completaron el cuestionario QEESI (Quick Environmental Exposure and Sensitivity Inventory). Resultados: Se ha incluido a 52 pacientes, con una edad media (desviación estándar) de 47,2 (7,6) años; 46 eran mujeres (88%). El origen del síndrome pudo relacionarse con una exposición laboral a productos químicos en 31 pacientes (59,6%) y en 14 de ellos fue una fumigación con insecticidas en el lugar de trabajo. En 20 casos (38,5%) el síndrome no pudo relacionarse con ninguna exposición tóxica y constituía una manifestación más de un síndrome de fatiga crónica. En el cuestionario QEESI obtuvieron una media de 72,9 (18,6) puntos en la escala de exposición inhalatoria; 45,5 (20,6) en la de exposición no inhalatoria; 69,8 (20,6) en la de gravedad de los síntomas; 4,4 (1,8) en la de identificación de la exposición, y 66,6 (21,7) en la de repercusión sobre las actividades de la vida diaria. Todos los casos fueron controlados durante un mínimo de 12 meses, período durante el cual permanecieron estables y no se registró ningún fallecimiento. Conclusiones: La SQM incide habitualmente en mujeres de mediana edad. En general se desencadena por una exposición a productos químicos y muy en particular a insecticidas. La asociación con el síndrome de fatiga crónica es frecuente. El pronóstico vital es bueno, pero se reduce considerablemente la calidad de vida de los pacientes

Background and objective: Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to various environmental chemicals. The objective of this study was to describe patients with MCS seen in our hospital. Patients and method: Patients consecutively seen by the Toxicology and Chronic Fatigue Units who presented symptoms of MCS were included. The diagnosis was clinical. All patients completed the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Results: Fifty-two patients were included. The average age (standard deviation) was 47.2 (7.6) years, and 46 (88%) were females. The origin of the syndrome was related to occupational exposure to various chemical agents in 31 cases (59.6%), including occupational accidents in 14 patients (fumigation of the workplace with insecticides). In 20 patients (38.5%), the syndrome could not be associated with any toxic exposure and was considered a manifestation of chronic fatigue syndrome. The QEESI showed mean scores of 72.9 (18.6) on the chemical inhalant intolerance scale, 45.5 (20.6) on the other intolerances scale, 69.8 (20.6) on the symptom severity scale, 4.4 (1.8) on the masking index and 66.6 (21.7) on the life impact scale. All patients were followed up for a minimum of 12 months, and during this period they remained stable with no deaths. Conclusions: MCS normally affects middle-aged women. It is frequently triggered by exposure to chemical agents, especially insecticides. An association with chronic fatigue syndrome is common. The prognosis is good but the patients' quality of life is seriously affected

[Cocaine abuse attended in the emergency department: an emerging pathology]. / Urgencias por cocáina: un problema emergente.

BACKGROUND AND OBJECTIVE: The consumption of cocaine has increased in Spain in recent years, leading to a probable increase in overdoses. The associated use of other drugs of abuse may be increasing the toxicity of cocaine, and therefore, increasing consultations to the emergency department (ED). PATIENTS AND METHOD: We collected patients seen by the ED of our hospital who reported cocaine consumption in the previous hours. The relationship between cocaine consumption and the reason for attending the ED was analysed. We reviewed the medical records of a sample of overdoses to determine the clinical profile. RESULTS: During the period 2002-2004, 745 patients were detected (average age 31 years, 68% males). The annual distribution was 223 cases in 2002, 232 in 2003, and 290 in 2004. Fifty-three percent of patients attended the ED at the weekend and 53% from 0:00 to 12:00 h. The main drugs associated with cocaine consumption were ethyl alcohol (38%), opiates (14%), cannabis (13%) and amphetamine derivatives (9%). Cocaine was the substance causing clinical symptoms in 70% of cases. The main reasons for attending the ED were anxiety or agitation (48%) and thoracic pain or palpitations (25%). Eleven percent of cases required hospital admission (19 intensive care unit) and 3 patients died. CONCLUSIONS: The consumption of cocaine, almost always associated with other drugs of abuse, has generated an increase in patients attending the ED. Although mortality is low, cocaine consumption generates substantial morbidity and frequent hospital admissions.

Urgencias por cocaína: un problema emergente / Cocaine abuse attended in the emergency department: an emerging pathology

Fundamento y objetivo: En los últimos años ha aumentado en España el consumo de cocaína, por lo que podrían estar produciéndose cada vez más episodios de sobredosis. El uso asociado de otras drogas de abuso puede potenciar su toxicidad y, por tanto, incrementar las consultas a los servicios de urgencias (SU). Pacientes y método: Se han recogido los datos de los pacientes que consultaron al SU y que referían consumo de cocaína en las horas previas. Se ha analizado la relación entre la droga y el motivo de consulta y se han revisado las historias clínicas de una muestra para conocer su perfil clínico. Resultados: Durante un período de 3 años (2002-2004) se identificó a 745 pacientes (edad media de 31 años, un 68% varones). La distribución anual fue de 223 casos en el año 2002, 232 en 2003 y 290 en 2004. El 53% de los pacientes consultaron durante el fin de semana y el 53% acudió al SU entre las 0 y las 12 h. Otras drogas asociadas al consumo de cocaína fueron el alcohol etílico (38%), los opiáceos (14%), el cannabis (13%) y los derivados anfetamínicos (9%). La cocaína fue el tóxico causante del cuadro clínico en el 70% de los casos. Los motivos principales de consulta fueron ansiedad o agitación (48%) y dolor torácico o palpitaciones (25%). El 11% requirió ingreso hospitalario (19 casos en la unidad de cuidados intensivos) y se registraron 3 casos mortales. Conclusiones: El consumo de cocaína, asociado casi siempre a otras drogas de abuso, ha generado un incremento de las consultas a los SU. Si bien la mortalidad es baja, el consumo de cocaína comporta morbilidad y frecuente ingreso hospitalario

Background and objective: The consumption of cocaine has increased in Spain in recent years, leading to a probable increase in overdoses. The associated use of other drugs of abuse may be increasing the toxicity of cocaine and, therefore, increasing consultations to the emergency department (ED). Patiensts and method: We collected patients seen by the ED of our hospital who reported cocaine consumption in the previous hours. The relationship between cocaine consumption and the reason for attending the ED was analysed. We reviewed the medical records of a sample of overdoses to determine the clinical profile. Results: During the period 2002-2004, 745 patients were detected (average age 31 years, 68% males). The annual distribution was 223 cases in 2002, 232 in 2003 and 290 in 2004. Fifty-three percent of patients attended the ED at the weekend and 53% from 0:00 to 12:00 h. The main drugs associated with cocaine consumption were ethyl alcohol (38%), opiates (14%), cannabis (13%) and amphetamine derivatives (9%). Cocaine was the substance causing clinical symptoms in 70% of cases. The main reasons for attending the ED were anxiety or agitation (48%) and thoracic pain or palpitations (25%). Eleven per cent of cases required hospital admission (19 in intensive care unit) and 3 patients died. Conclusions: The consumption of cocaine, almost always associated with other drugs of abuse, has generated an increase in patients attending the ED. Although mortality is low, cocaine consumption generates substantial morbidity and frequent hospital admissions