Estudio descriptivo del síndrome confusional agudo en Urgencias / Descriptive study of delirium in the emergency department

Objetivo: Conocer mejor las variables clínicas, funcionales y analíticas que se asocian al síndrome confusional agudo (SCA) en urgencias y la evolución de las mismas con el fin de obtener una mejora en el abordaje terapéutico del paciente anciano previniendo así la morbimortalidad en este tipo de pacientes. Diseño: Se trata de un estudio descriptivo prospectivo de SCA en urgencias. Emplazamiento: Hospital General Universitario de Ciudad Real. Participantes: Se incluyó, en el intervalo de las 24 h siguientes al ingreso en el Servicio de Geriatría, a todos los pacientes procedentes del Servicio de Urgencias con diagnóstico de SCA. Mediciones principales: Se realizó un análisis de las variables del conjunto de datos (variables sociodemográficas y clínicas), calculando tablas de frecuencias para variables de tipo cualitativo y estadísticos descriptivos para las variables cuantitativas. Posteriormente, se han empleado técnicas de inferencia estadística. Resultados: El antecedente médico más frecuente fueron la enfermedad neurológica y la HTA, seguida de las enfermedades reumatológicas. Los motivos de consulta principales fueron el deterioro del estado general, la disnea, la disminución del nivel de consciencia y la fiebre. Se debe destacar la incidencia de la polifarmacia, especialmente de fármacos como los diuréticos, benzodiacepinas o hipnóticos. En relación con la etiología principal, destaca el papel de las infecciones de tipo urinario y respiratorio. Conclusiones: Se destaca el papel fundamental de las enfermedades neurológicas (especialmente la demencia), la HTA, la polifarmacia (uso inadecuado de benzodiacepinas e hipnóticos) y las infecciones urinarias y respiratorias como factores tratables o prevenibles del delirium en el paciente de Atención Primaria en nuestro medio.(AU)

Objective: To better understand the clinical, functional and analytical variables associated with delirium in emergencies and their evolution in order to obtain an improvement in the therapeutic approach of the elderly patient, thus preventing morbidity and mortality in this type of patient. Design: This is a prospective descriptive study of acute confusional syndrome in the emergency department. Site: General University Hospital of Ciudad Real. Participants: All patients from the emergency department with a diagnosis of delirium were included in the 24-h interval following admission to the geriatric service. Main measurements: An analysis of the variables of the data set (sociodemographic and clinical variables) was performed, calculating frequency tables for qualitative variables and descriptive statistics for quantitative variables. Subsequently, statistical inference techniques have been used. Results: The most frequent medical antecedent were neurological pathology and hypertension, followed by rheumatologic diseases. The main reasons for consultation were deterioration in general condition, dyspnea, decreased level of consciousness, and fever. Highlight the incidence of polypharmacy, especially drugs such as diuretics, benzodiazepines or hypnotics. In relation to the main etiology, the role of urinary and respiratory infections is noteworthy. Conclusions: Highlight the fundamental role of neurological diseases (especially dementia), hypertension, polypharmacy (inappropriate use of benzodiazepines and hypnotics) and urinary and respiratory infections as treatable and/or preventable factors of delirium in Primary Care patients in our setting.(AU)

[Descriptive study of delirium in the emergency department]. / Estudio descriptivo del síndrome confusional agudo en Urgencias.

OBJECTIVE: To better understand the clinical, functional and analytical variables associated with delirium in emergencies and their evolution in order to obtain an improvement in the therapeutic approach of the elderly patient, thus preventing morbidity and mortality in this type of patient. DESIGN: This is a prospective descriptive study of acute confusional syndrome in the emergency department. SITE: General University Hospital of Ciudad Real. PARTICIPANTS: All patients from the emergency department with a diagnosis of delirium were included in the 24-h interval following admission to the geriatric service. MAIN MEASUREMENTS: An analysis of the variables of the data set (sociodemographic and clinical variables) was performed, calculating frequency tables for qualitative variables and descriptive statistics for quantitative variables. Subsequently, statistical inference techniques have been used. RESULTS: The most frequent medical antecedent were neurological pathology and hypertension, followed by rheumatologic diseases. The main reasons for consultation were deterioration in general condition, dyspnea, decreased level of consciousness, and fever. Highlight the incidence of polypharmacy, especially drugs such as diuretics, benzodiazepines or hypnotics. In relation to the main etiology, the role of urinary and respiratory infections is noteworthy. CONCLUSIONS: Highlight the fundamental role of neurological diseases (especially dementia), hypertension, polypharmacy (inappropriate use of benzodiazepines and hypnotics) and urinary and respiratory infections as treatable and/or preventable factors of delirium in Primary Care patients in our setting.

Hypothalamic dopamine signaling regulates brown fat thermogenesis.

Dopamine signaling is a crucial part of the brain reward system and can affect feeding behavior. Dopamine receptors are also expressed in the hypothalamus, which is known to control energy metabolism in peripheral tissues. Here we show that pharmacological or chemogenetic stimulation of dopamine receptor 2 (D2R) expressing cells in the lateral hypothalamic area (LHA) and the zona incerta (ZI) decreases body weight and stimulates brown fat activity in rodents in a feeding-independent manner. LHA/ZI D2R stimulation requires an intact sympathetic nervous system and orexin system to exert its action and involves inhibition of PI3K in the LHA/ZI. We further demonstrate that, as early as 3 months after onset of treatment, patients treated with the D2R agonist cabergoline experience an increase in energy expenditure that persists for one year, leading to total body weight and fat loss through a prolactin-independent mechanism. Our results may provide a mechanistic explanation for how clinically used D2R agonists act in the CNS to regulate energy balance.

Parálisis facial bilateral. Presentación atípica de un Síndrome de Guillain-Barré / Facial bilateral paralysis. Atypical presentation of Guillain-Barré Syndrome

El Síndrome de Guillain-Barré (SGB) es una enfermedad desmielinizante aguda cuya manifestación típica es la debilidad muscular simétrica y ascendente y la ausencia de reflejos osteotendinosos. Sin embargo, existen otras formas de presentación como la paralisis facial bilateral (PFB) que hay que tener en cuenta a la hora de realizar el diagnóstico, ya que la administración temprana de inmunoglobulinas favorece la recuperación clínica evitando la aparición de complicaciones. La PFB es una entidad rara cuyas causas más frecuentes son traumatismos craneoencefálicos, enfermedades infecciosas, neurológicas y alteraciones de origen indeterminado como el SGB. Presentamos el caso de una paciente que acudió al servicio de urgencias por una PFB sin otra focalidad neurológica asociada. Tras la realización de analíticas, tomografía axial computerizada (TAC) craneal y punción lumbar (PL), fue diagnosticada de SGB y recibió tratamiento con inmunoglobulinas intravenosas

The Guillain-Barré Syndrome (GBS) is an acute demyelinating disease whose typical manifestation is symmetrical and ascending muscle weakness and absence of osteotendinous reflexes. However, there are other forms of presentation, such as bilateral facial palsy (BFP) that must be taken into account when making the diagnosis, since the early administration of immunoglobulins favors clinical recovery, avoiding the occurrence of complications. The BFP is a rare entity whose most frequent causes are traumatic brain injury, infectious diseases, neurological diseases and alterations of indeterminate origin, such as GBS. We present the case of a patient who came to the emergency department for a BFP without any other associated focal neurologic signs, who, after undergoing blood tests, cranial computed tomography (CAT) and lumbar puncture (LBP) was diagnosed with GBS and received treatment with intravenous immunoglobulins