¿Son efectivos nuestros centros de reconocimiento médico valorando la aptitud psicofísica para permisos de conducción y licencias de armas? / Are our medical centres for fitness to drive and firearms licences effective?

Objetivos. Este artículo se propuso evaluar la efectividad de los centros de reconocimiento médico en la valoración de la aptitud psicofísica para permisos de conducción y licencias de armas, describiendo las diferencias observadas en sendas valoraciones. Método. Mediante un diseño transversal se tomó una muestra representativa de titulares de permisos de conducción y licencia de armas calificados como aptos en la provincia de Málaga durante 2014 (363 informes para permisos de conducción y 626 para licencia de armas), evaluando la concordancia de la aptitud psicofísica informada por los centros con los registros del Servicio Andaluz de Salud. Se estimó la proporción de dichos titulares que no reunirían los requisitos legales de aptitud, analizando el origen de las discordancias en relación con la información de la que dispusieron los centros. Resultados. Se estimó la discordancia en la valoración de la aptitud psicofísica para permisos de conducción en 15,4% (IC 95%: 12,0 a 19,4), proporción 2,7 veces mayor para licencias de armas (41,4%), relacionándose el origen de la discordancia con la información que dispuso el centro más que a la calificación realizada por estos. Conclusiones. Es limitada la efectividad de los centros en la valoración de la aptitud psicofísica para permisos de conducción y, especialmente, para licencias de armas. Podría mejorar con un mayor seguimiento de su actividad, disponiendo de personal sanitario con formación adecuada y acceso a los registros asistenciales de los solicitantes (AU)

Objectives. This article aimed to evaluate the effectiveness of medical centres in the assessment of medical fitness for driving and gun licences, as well as describing the differences between them. Method. Using a crossover design and a representative sample of holders of driving and firearms licences in the province of Malaga during 2014 (363 reports for driving licenses and 626 for firearms licenses), an assessment was made of fitness report issued by the centres by comparing it with the records of the Andalusian public health service. The proportion of those that would not meet the legal eligibility requirements was calculated. An analysis was made of the origin of the disagreements as regards the information made available by the centres. Results. The discordance in the assessment of fitness to drive was estimated as 15.4% (95% CI: 12.0 to 19.4), while for firearms licenses it was 2.7 times higher (41.4%). The origin of the discordance is related to the information provided to the centres, rather than the assessment made by them. Conclusions. The limited effectiveness of the centres in the assessment of fitness for driving and, especially, for firearms licenses, could be improved by increased monitoring of their activity, providing health workers with adequate training and access to healthcare records of applicants (AU)

[Are our medical centres for fitness to drive and firearms licences effective?]. / ¿Son efectivos nuestros centros de reconocimiento médico valorando la aptitud psicofísica para permisos de conducción y licencias de armas?

OBJECTIVES: This article aimed to evaluate the effectiveness of medical centres in the assessment of medical fitness for driving and gun licences, as well as describing the differences between them. METHOD: Using a crossover design and a representative sample of holders of driving and firearms licences in the province of Malaga during 2014 (363 reports for driving licenses and 626 for firearms licenses), an assessment was made of fitness report issued by the centres by comparing it with the records of the Andalusian public health service. The proportion of those that would not meet the legal eligibility requirements was calculated. An analysis was made of the origin of the disagreements as regards the information made available by the centres. RESULTS: The discordance in the assessment of fitness to drive was estimated as 15.4% (95% CI: 12.0 to 19.4), while for firearms licenses it was 2.7 times higher (41.4%). The origin of the discordance is related to the information provided to the centres, rather than the assessment made by them. CONCLUSIONS: The limited effectiveness of the centres in the assessment of fitness for driving and, especially, for firearms licenses, could be improved by increased monitoring of their activity, providing health workers with adequate training and access to healthcare records of applicants.

Prolongation of the QTc interval during alcohol withdrawal syndrome.

BACKGROUND: Cardiac arrhythmias might explain cases of sudden death in alcoholics during ethanol abstinence. AIM OF STUDY: To evaluate QT interval (and its outcome) in patients with alcohol withdrawal syndrome. PATIENTS AND METHODS: Sixty-two patients (52 male and 10 female, mean age 43.7 years, range 18-71 years), admitted to the hospital as a result of alcohol abstinence syndrome (tremulousness in 7 cases, agitation in 12 cases, delirium tremens in 11 cases, and seizures in 32) were studied. The QT interval was measured on 12 lead ECGs performed on admission in all cases. QTc was obtained using Bazett's formula. In 27 patients a second ECG was performed during hospital stay. Results. Mean QTc interval on admission was 439 +/- 32 ms (range 350-525 ms); 29 patients (46.8%) showed a prolonged (> 440 ms) QTc interval. No significant differences were observed between patients with normal and high QTc values as regards to age, sex, type of withdrawal syndrome, duration of abstinence, liver function tests, serum electrolytes or blood cell counts. In cases where two ECG recordings could be evaluated (n = 27), the mean QTc interval was significantly shorter in the latter than in the former (417 +/- 26 ms versus 447 +/- 30 ms, respectively, p < 0.001). Eight patients found to have prolonged QTc on admission had a second ECG performed on them after complete recovery from withdrawal symptoms. In all these cases the QTc interval eventually became normal. CONCLUSION: The QTc interval is frequently prolonged during alcohol withdrawal syndrome and tends to become normal over time, along with remission of abstinence symptoms.

Splenic embolization prior to myelosuppressive treatment in hepatocarcinoma and active chronic hepatitis.

In the treatment of active chronic hepatitis and hepatocellular carcinoma some effective drugs can produce myelosuppression. Hypersplenism may considerably limit the dosage of such drugs. Splenectomy is an effective treatment for hypersplenism, although it is not without complications. Partial splenic embolization is a good and safe procedure; 15 patients were treated in order to achieve higher platelet and leukocyte counts. Embolization has been performed with gelfoam with local and systemic antibiotics (Spigos' protocol) and 50-75% of the splenic parenchyma was infarcted. All patients could be treated for the underlying hepatopathy with adequate dosages of interferon or chemotherapeutic drugs.

The open-ended guidewire as superselective catheter for intraarterial chemotherapy: experience in 190 procedures.

With intraarterial infusion, high levels of chemotherapeutic agents can be achieved in the tumoral area. We present our experience with open-ended guidewire (OEGW) associated with steerable guidewires (SGW) as superselective catheters for intraarterial chemotherapeutic infusion and embolization. This technique was used successfully in 62 patients (190 procedures) over 15 months.

[A low-level stress test, in the early phase of myocardial infarction and its correlation with coronary angiography]. / Prueba de esfuerzo de bajo nivel, en la fase temprana del infarto del miocardio y su correlación con la coronariografía.

In a prospective 24-month trial at the Instituto Nacional de Cardiologia, 56 patients were studied. All patients had acute myocardial infarction (AMI), diagnosed by clinical, electrocardiographic and enzymatic means. They were studied in two groups: Group A with single localized AMI (n = 30) and Group B with AMI at two locations (n = 26); a resting electrocardiogram (EKG) was analyzed in each case and a low level stress test was performed within the 2nd and 3rd postinfarction weeks; coronary angiography was done between the 8th and 9th postinfarction weeks. In Group A the low level stress test (LLST) was positive for ischemia at a distance from the infarction site in 21, and eighteen of them had multi-vessel injuries (MVI); in 9 the LLST was negative; of these 7 had single-vessel injury; only the remaining 2 had MVI (p less than 0.001) with 90% sensitivity and 78% specificity. In Group B there was no significant relationship between LLST and coronary angiography (64% sensitivity, and 62% specificity). Relating the ischemic change at a distance in the resting EKG with coronary angiography, we found 75% sensitivity and 55% specificity in Group A. In Group B, sensitivity and specificity were even lower. We conclude that LLST in the early postinfarction phase in Group A is a safe and reliable method to suspect MVI, allowing the early identification of patients with lesions that could be treated by surgical means.

[Arrhythmia in acute myocardial infarction with involvement of the right ventricle]. / Disritmias en el infarto agudo del miocardio con extensión al ventrículo derecho.

Arrhythmias and conduction disorders were studied in 110 patients with posteroinferior myocardial infarction with right ventricular involvement. All the patients were hospitalized in the coronary care unit, and were compared with another 110 patients with posteroinferior myocardial infarction without extension to the right ventricle. 99% of the patients with right ventricular infarction and 96.3% of the patients with isolated inferior infarction had some type of arrhythmia. The disorders of automatism were similar in both groups (90% vs 91%, respectively). The conduction disturbances were observed in 68% of the infarctions extended to the right ventricle and in 20% of the isolated left ventricular infarctions (p greater than 0.01). A-V block occurred in 52% of the infarctions with right ventricular involvement and only in 10.9% of the control group. Intraventricular conduction disorders also were more frequent in right ventricular infarction (24.5% vs 10.9%) (p less than 0.02), especially the RBBB (18.2% vs 6.4%). Ventricular fibrillation was observed in 5.5% and 0.9%, and polymorphic ventricular tachycardia (torsades de pointes) in 12.7% and 1.9% respectively. In 62 patients with right ventricular infarction it was necessary to implant a pacemaker as compared to 12 patients in the control group. Mortality was higher in the patients with inferior infarction extended to the right ventricle (23 patients vs 2 patients). None of the deaths were due to arrhythmias. It can be concluded that conduction disorders and the number of pacemaker implants are more common in the infarctions with right ventricular involvement due to more severe damage to the conduction system.