Diagnóstico precoz del síndrome coronario agudo en los servicios de urgencias. Papel de la h-FABP / Early diagnosis of acute coronary syndrome in the emergency department. The-FABP role

Objetivos: Analizar las características epidemiológicas de los pacientes atendidos en urgencias con sospecha de síndrome coronario agudo (SCA), evaluar los diferentes marcadores empleados en el diagnóstico y determinar la utilidad clínica de un test cualitativo que mide los niveles de la proteína transportadora de ácidos grasos específica del miocardio (h-FABP) en sangre para la identificación precoz del SCA. Métodos: Estudio multicéntrico prospectivo incluyendo pacientes atendidos en el Servicio de Urgencias con dolor torácico sugestivo de síndrome coronario agudo de menos de 180 minutos de duración. Se analizaron variables epidemiológicas incluyendo edad, sexo, duración de dolor y presencia de factores de riesgo vascular. Se compararon los resultados de h-FABP con los de la troponina T. Se consideran positivos los niveles >7 ng/ml de h-FABP. Resultados: Los datos fueron obtenidos de 419 pacientes, con diagnóstico final de SCA en 237 (56 por ciento). La sensibilidad diagnóstica de la proteína transportadora de ácidos grasos específica del miocardio fue del 47 por ciento, significativamente más alta que la de la troponina T (12 por ciento; p<0,05). La especificidad de la troponina T fue mayor aunque no significativamente. Ninguno de los factores de riesgo vascular analizados excepto la presencia de enfermedad cardiovascular periférica fue significativamente más elevado en el grupo de pacientes con diagnóstico final de SCA. Conclusiones: La proteína transportadora de ácidos grasos específica del miocardio puede ser útil en la evaluación de pacientes con sospecha de síndrome coronario agudo en fases precoces (AU)

[Levels of lead, cadmium, zinc and arsenic in the water in the province of Salamanca. Multidepartmental coordinated project of investigation supported by the Junta of Castilla Leon in 1884]. / Estudio de los niveles de plomo, cadmio, zinc y arsénico, en aguas de la provincia de Salamanca. Proyecto de Investigación Coordinado Multidepartamental subvencionado por la Junta de Castilla León n.o 1884.

BACKGROUND: To establish the degree of contamination by lead, cadmium, zinc and arsenic in the water in Salamanca province and its relationship with the provenance of the samples and their collection point. METHODS: Transverse, observational, descriptive epidemiological study. Province of Salamanca. RESULTS: Water from water pipes, fountains, springs, wells, rivers, streams and lakes in the province of Salamanca were studied, analyzing the lead, cadmium, zinc and arsenic contents of 180 samples using Atomic Absorption Spectroscopy. Results indicated that 56% of samples analyzed showed toxic levels of cadmium, and 28% of samples gave toxic levels of lead, but showed tolerable levels of zinc and arsenic. No major differences were observed in the degree of contamination by the four elements between the four provincial district areas. Levels of contamination by the four elements were compared for water from the water supply, and samples from wells, fountains, springs and surface water, showing similar contents of the elements studied. CONCLUSIONS: Findings suggest that the water in the province of Salamanca shows "naturally" high cadmium and lead content, probably due to the geological characteristics of the terrain.

[Self-aggressive behaviors in the emergency service]. / Las conductas autoagresivas en el servicio de urgencias.

OBJECTIVE: To discover the characteristics of self-damaging acts attended at a casualty department. DESIGN: Descriptive/retrospective study. SETTING: Hospital context. PATIENTS AND OTHER PARTICIPANTS: Those attended for damage to themselves in the Avila Hospital Casualty Department over a two-year period. MEASUREMENTS AND MAIN RESULTS: For the 62 cases surveyed, age, gender, source of referral, the method used, diagnosis, hour of arrival, length of time in the Department, destination on release and the seriousness of the act, were all evaluated. The most common method was taking drugs (72.6%). Among women (56.4%), emotional, personality and adaptive disorders predominated. Men (43.5%) were more commonly schizophrenic and showed abuse of/dependence on alcohol and drugs. They were also the most serious cases. 53.2% of cases required psychiatric admittance. CONCLUSIONS: Emotional disturbances and personality disorders were the most common cause of this type of behaviour.

[Antiphospholipid antibodies and cerebral infarction]. / Anticuerpos antifosfolípido e infartos cerebrales.

The antiphospholipid antibodies syndrome is clinically characterized by the presence of thrombosis, repetitive abortions and/or thrombopenia. During the past years, thanks to the development of techniques for its detection, its relationship with cerebrovascular accidents has become of special interest. Two patients with antiphospholipid antibodies and multiple cerebral infarcts are presented and the clinical and pathogenic aspects of this association are reviewed.

[Clinical application of the dexamethasone suppression test in the differentiation of subgroups in anorexia nervosa]. / Aplicación clínica del "test" de supresión con dexametasona en la diferenciación de subgrupos en la anorexia nerviosa.

This paper analyzes the usefulness of DST to identify subgroups in 27 patients with anorexia nervosa. The results obtained from this investigation don't show significant differences between the suppressors and nonsuppressors based on any of the following variables: weight loss, age, duration of the illness, weight at admittance, percentage of ideal weight and cortisol and ACTH baseline levels. However, we have found a correlation between substantially underweight patients (less than 75% of the ideal weight) and nonsuppression, and between bulimic episodes and suppression. 74.1% of our patients had abnormal DST. The DST does not appear to be useful to establish anorexia nervosa subgroups.

[An MMPI subscale for assessment alexithymia in duodenal ulcer patients]. / Una subescala del M.M.P.I. para la medida de la alexitimia en pacientes con E.U.D.

We measured the alexithymia by the Kleiger-Kinsman scale in 36 patients with D.U.D. We employed 34 patients with irritables Bowel Syndrome and 30 patients with chronic organic pathologia as control groups. Our results show two possible conclusions: 1) The absence alexithymia's specificity in our ulcerous patients and/or the incapacity of this M.M.P.I.'s subescale to discriminate this feature in the psichosomatic diseases.

[Psychosocial and clinical-course factors in anorexia nervosa]. / Estudio de factores psicosociales y evolutivos en la anorexia nerviosa.

This study assesses the psychosocial factors of 27 patients diagnosed of Anorexia Nervosa and studies them in three different context: the age at which the illness appears, presence or absence of bulimic episodes and the evolution of the illness. The masculine sex and the lower middle class are factors that appear to be associated with an unfavorable evolution. Finally there is a discussion about the relevance of the different psychosocial factors.

[Duodenal ulcer disease. A controlled study of aggressiveness and other personality factors]. / La enfermedad ulcerosa duodenal. Un estudio controlado de la agresividad y otros factores de la personalidad.

We study the aggressivity level and its direction in the context of personality, in 36 patients with DUD (23 males and 13 females). We employed 30 patients with chronic disease (15 men with COPD and 15 female with arthrosis) as control groups, in addition to the normal population. The purpose of this investigation is to determinate if suffering or chronicity could determinate psychopathological findings similar to those described in the literature about patients with DUD. The results point out that we can not consider a specific ulcerous personality, but a psychophysiological reaction or psychopathological alterations resulting from a somatic disease, on the other hand the autoaggressivity factor pulsion-inhibition, is the most reliable variable when compared with control groups (p less than 0.05-0.01).

[Measurement of aggressiveness and its direction in patients with duodenal ulcer. A double-control study]. / La medida de la agresividad y su dirección en pacientes con ulcus duodenal. Un estudio de doble control.

We measure aggressivity in 36 patients with DUD (duodenal ulcer disease). We use two control groups as sample: normal population and other group of chronic organic pathologies. The results denote that the autoaggression-inhibition factor is the best discriminate variable to our group of duodenal ulcer patients of both sexes.