Intoxicación aguda por anestésicos locales / Acute toxicity due to local anesthetics

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Multiingreso en el Servicio de Medicina Interna de un hospital terciario / Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital

Antecedentes y objetivos. El paciente multiingresador origina un gran consumo de recursos sanitarios. Hemos estudiado los factores asociados con el ingreso hospitalario múltiple en una cohorte de pacientes asistidos en un Servicio de Medicina Interna. Pacientes y métodos. Se analizaron 613 ingresos hospitalarios consecutivos. Se definió como paciente multiingresador a aquel que al ingresar contabilizaba 3 ingresos o más en los últimos 12 meses. Se analizó la relación de factores demográficos, clínicos y sociales con la característica de ser multiingresador. Además, se analizó el reingreso en los 6 meses siguientes al alta así como el fallecimiento en el ingreso y en los 6 y 12 meses siguientes al alta. Resultados. Los multiingresadores se caracterizaron frente a los no multiingresadores por ser de sexo masculino, ser más jóvenes y presentar mayor comorbilidad, mayor consumo de medicaciones y mayor puntuación en el índice de Katz. La principal causa de ingreso de los multiingresadores fue la «descompensación de una enfermedad crónica» (87,3%). Las enfermedades que se asociaron de forma más destacada con el multiingreso fueron la insuficiencia cardiaca, la diabetes mellitus y la enfermedad pulmonar obstructiva crónica. En los 6 primeros meses tras el alta los multiingresadores presentaron más reingresos. Durante el periodo de estudio, falleció el 40,4% de los pacientes multiingresadores y el 28,8% de los pacientes no multiingresadores. Conclusiones. Los pacientes multiingresadores presentaron mayor complejidad clínica que los no multiingresadores, y el multiingreso se asoció con las enfermedades crónicas, la polifarmacia, el deterioro funcional y tasas elevadas de mortalidad (AU)

Background and objectives. Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. Patients and methods. A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. Results. When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. Conclusions. Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates (AU)

Multiple hospitalizations at the Department of Internal Medicine of a tertiary hospital. / Multiingreso en el Servicio de Medicina Interna de un hospital terciario.

BACKGROUND AND OBJECTIVES: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year. We analyzed the relationship between demographic, clinical and societal factors on one hand and having been hospitalized on multiple occasions on the other. We also analyzed readmissions in the 6 months after discharge, as well as mortality during the hospitalization and in the 6 and 12 months after discharge. RESULTS: When compared with patients who have not been hospitalized on multiple occasions, multiple-hospitalization patients are more likely to be male, younger and to have greater comorbidity, greater consumption of medicines and higher Katz Index scores. The main cause for admission for multiple-hospitalizations patients was chronic disease decompensation (87.3%). The diseases that were most obviously associated with multiple hospitalizations were heart failure, diabetes mellitus and chronic obstructive pulmonary disease. In the first 6 months after discharge, multiple-hospitalization patients had a greater number of readmissions. During the study period, 40.4% of the multiple-hospitalization patients died, and 28.8% of the nonmultiple-hospitalization patients died. CONCLUSIONS: Multiple-hospitalization patients have a greater clinical complexity than nonmultiple-hospitalization patients, and multiple hospitalizations are associated with chronic diseases, polypharmacy, functional impairment and high mortality rates.

[Splenic disorders in internal medicines]. / Lesiones esplénicas en medicina interna.

The spleen is the largest lymphopoietic organ, containing 25% of total lymphoid mass. It participates in cellular and humoral immunity and intervenes in the renovation of red cells and the elimination of bacteria. Splenic functions are reduced when the spleen is absent, which entails, amongst other complications, greater susceptibility to suffering from sepsis due to encapsulated organisms. We present 6 clinical cases admitted to the Internal Medicine serve with splenic pathology and we make a review of the approach to be used. The spectrum of splenic lesions in internal medicine is very wide. On occasions, a splenic pathology can be suspected due to clinical history, physical exploration or because of cytopenias in the analyses. Different complementary tests are available for completing study of these lesions. A splenectomy can be carried out in case of diagnostic doubt, with the most frequent diagnoses being hepatic cirrhosis and lymphoma/leukaemia.

Lesiones esplénicas en medicina interna / Splenic disorders in internal medicines

El bazo representa el mayor órgano linfopoyético, contiene el 25 % de la masa linfoide total. Participa en la inmunidad celular y humoral e interviene en la renovación de los glóbulos rojos y en la eliminación de las bacterias. Las funciones esplénicas están reducidas cuando el bazo está ausente, lo que implica entre otras complicaciones, una mayor susceptibilidad para padecer una sepsis por organismos encapsulados. Se presentan 6 casos clínicos ingresados en el servicio de Medicina Interna con patología esplénica y se hace una revisión del abordaje a realizar. El espectro de lesiones esplénicas en medicina interna es muy amplio. En ocasiones se puede sospechar patología esplénica por la historia clínica, la exploración física o por citopenias en los análisis. Disponemos de diversas pruebas complementarias para completar el estudio de dichas lesiones. En caso de duda diagnóstica se puede realizar esplenectomía siendo los diagnósticos más frecuentes la cirrosis hepática y el linfoma/leucemia (AU)

The spleen is the largest lymphopoietic organ, containing 25 % of total lymphoid mass. It participates in cellular and humoral immunity and intervenes in the renovation of red cells and the elimination of bacteria. Splenic functions are reduced when the spleen is absent, which entails, amongst other complications, greater susceptibility to suffering from sepsis due to encapsulated organisms. We present 6 clinical cases admitted to the Internal Medicine serve with splenic pathology and we make a review of the approach to be used. The spectrum of splenic lesions in internal medicine is very wide. On occasions, a splenic pathology can be suspected due to clinical history, physical exploration or because of cytopenias in the analyses. Different complementary tests are available for completing study of these lesions. A splenectomy can be carried out in case of diagnostic doubt, with the most frequent diagnoses being hepatic cirrhosis and lymphoma/leukaemia (AU)

Respuesta de los autores: Suicidios violentos y fuentes forenses / No disponible

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Politraumatizados con intencionalidad suicida. Estudio epidemiológico de base poblacional en Navarra durante los años 2004-2005 / Severe multiple injuries after suicide attempts: population-based epidemiologic study in Navarre, Spain, between 2004 and 2005

Se estudia las características epidemiológicas de los politraumatizados atendidos por el Sistema de Emergencias de Navarra los años 2004 y 2005 cuya motivación fue el suicidio. Para ello, se incluyó pacientes con una o varias lesiones traumáticas graves, producidas por energía mecánica, que pueden comprometer su vida o provocar graves secuelas, y cuya intencionalidad fue el suicidio. Se incluyeron pacientes que en el momento de su atención presentaron un New Injury Severity Score (NISS) superior a 15 o fallecieron. La tasa de incidencia anual por 100.000 habitantes fue de 5,7. La relación hombres: mujeres fue de 3:1. El mecanismo más frecuentemente utilizado es la precipitación de altura, en segundo lugar el atropello por ferrocarril y las lesiones por arma de fuego en tercer lugar. Falleció el 80% de los pacientes, con una edad media de 50 años. La mujer utiliza preferentemente la precipitación de altura y el hombre también otros métodos. El NISS medio fue de 37 puntos. Se concluye que el suicidio por métodos violentos presenta bajas tasas de incidencia en Navarra. Es un método con una alta mortalidad por la gravedad de las lesiones es utilizado fundamentalmente por varones. Las mujeres utilizan preferentemente la precipitación de altura mientras que los hombres utilizan también otros métodos (AU)

We to study the epidemiologic characteristics of patients with multiple injuries after attempted suicide who were treated by the emergency health system of Navarre between 2004 and 2005. The patients that had 1 or more severe injuries from mechanical force after a suicide attempt were included. The injuries were life-threatening or could be the cause of severe complications or sequelae. An inclusion criterion was a New Injury Severity Score (NISS) of more than 15, or death. The annual incidence of such injuries was 5.7 per 100 000 population. The ratio of men to women was 3:1. In order of frequency, the most common methods were jumping from a high place, jumping in front of an oncoming train, and gunshot. Eighty percent of the patients died. The mean age was 50 years. Jumping from heights was chosen most often by both men and women, but men also chose the other methods (train and gunshot) more often than women. The mean NISS was 37 points. We conclude that the incidence of violent suicide is low in Navarre. Mortality is high because of the severity of injuries caused by the methods chosen mainly by men. Women mainly choose jumping from heights whereas men use additional methods (AU)

A multidimensional approach to the generation of helmets' design criteria: a preliminar study.

The design and development process of helmets incorporates systematically design criteria related to safety to accomplish European and local standards for the commercialization. However, there are few studies focused on user's comfort and adaptation. Present study tackles a multidimensional approach to gain better understanding of the interaction between helmet and user to generate design criteria for the internal helmet surface. Morphological characteristics of the target population, pressure distribution over head and subjective perception of fitting and discomfort are the factors considered to establish the criteria that assure a proper fit. Ten men corresponding to helmet size M and usual drivers of motorbike wore two helmet models in three sizes (S, M and L). The head shape of participants was acquired using the head scanner of I-Ware laboratory and an instrumented pad was used to measure pressure in five head regions. After wearing the helmet, users filled in a perception questionnaire about fitting, comfort and usability considering the five regions. Users' fitting perception provided the relation between pressure levels and the comfort felt in the five regions. This study constitutes a first approach to a new methodology to generate criteria to improve the design of helmets under a multidimensional approach.

A study of the viability of obtaining a generic animation of the foot while walking for the virtual testing of footwear using dorsal pressures.

Establishing the appropriate pressure exerted by the shoe upper over the foot surface is fundamental for the design of specific footwear, although measuring the dorsal pressures can also provide important additional information. In previous works, a virtual simulator to perform studies of comfort and functionality in CAD footwear design was presented. This paper describes the procedure carried out to obtain the foot animations used in this simulator. The virtual feet used in the simulator are feet without a standard form scanned in a static way. Their movements are rebuilt from the register of movements of several foot anatomical points during a complete step. The dorsal pressures exerted by some shoe uppers on these anatomical points were measured for several subjects and used to establish the viability of the use of these animations in a virtual simulator for footwear.

Características clinicoanalíticas y complicaciones de pacientes con mononucleosis infecciosa derivados desde atención primaria a atención especializada / Clinical and analytic characteristics and complications in patients with infectious mononucleosis referred from primary care to specialists

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