Francisco Javier Gómez Jiménez

Factores pronósticos de mortalidad en la parada cardiorrespiratoria extrahospitalaria

Fundamento Y Objetivo Determinar los factores pronosticos de mortalidad en la parada cardiorrespiratoriaatendida por los equipos de emergencias del 061 de Andalucia. Pacientes Y Metodo Estudio observacional retrospectivo, desde enero de 1998 hasta diciembrede 1999, de 1.950 paradas cardiorrespiratorias extrahospitalarias (PCRE) atendidas por losequipos de emergencia (EE) de Andalucia. Se determino un modelo multivariado mediante regresionlogistica para identificar aquellos factores que pueden predecir de modo conjunto lamortalidad. Para la calibracion del modelo, utilizamos el test de Hosmer-Lemeshow, y para ladiscriminacion del modelo calculamos el area bajo la curva ROC. Resultados La incidencia de PCRE fue de 27/100.000. De nuestra poblacion de 1.950 pacientes,1.393 eran varones y 552 mujeres, con una media (DE) de edad de 61,3 (28,4) anos.Un 24,95% (n = 483) ingresaron vivos en el hospital y un 75,05% (n = 1.444) fallecieron enel medio extrahospitalario. El modelo determino como factores pronosticos de mortalidad: elpersonal que realiza las maniobras de reanimacion cardiopulmonar (RCP) previas a la llegadadel EE (sanitario/no sanitario); la presencia de desfibrilacion; el numero de desfibrilaciones, ellugar donde ocurre la PCR; las categorias de funcion general (OPC) antes de la PCR y el minutode inicio del masaje cardiaco por EE. Conclusiones Segun nuestros resultados, para poder disminuir la mortalidad por PCRE ennuestro medio se hace necesario disminuir los tiempos de demora para agilizar la desfibrilaciontemprana y el masaje cardiaco por los EE, asi como una concienciacion y educacion sanitariamayores por parte de la poblacion general y de los sanitarios implicados en la cadena de supervivencia. Background and Objective Our purpose was to determine the prognostic factors of mortalityamong patients with cardiorespiratory arrest (CRA) assisted by 061 emergency teams in Andalusia. Patients and Method Retrospective observational study from January 1998 to December 1999of 1950 cases of out-of-hospital CRA (OH-CRA) assisted by Andalusian 061 emergency teams(ETs). Independent (predictor) variables considered in the study were those defined in the Utsteinstyle, after categorization. The dependent (outcome) variable was out-of-hospital mortality.A multivariate model was constructed using logistic regression to define the factors that, whenconsidered together, predict mortality. The model was calibrated using the Hosmer-Lemeshowtest. For the discrimination of the model, we calculated the area under the ROC curve. Results The incidence of OH-CRA was 27/100,000. Among our population of 1950 patients,24.95% (483) were admitted alive to hospital and 75.05% (1444) died in the out-of hospitalsetting; 1393 patients were male and 552 were female. The mean age was 61.3 ± 28.4 years.The model revealed the following mortality prognostic factors: personnel performing cadiopulmonaryresuscitation before ET arrival (healthcare/non-healthcare), presence of defibrillation,number of defibrillations, CRA site, general function categories before CRA, and cardiacmassage within the first minute by ET. Conclusions In order to reduce the CRA-induced mortality in our setting, defibrillation and cardiacmassage by ETs must be done without delay. It is fundamental to achieve greater healthawareness and education among both the general population and the healthcare workers involvedin the survival chain.

Prescripción de especialidades farmacéuticas genéricas en informes de alta de un hospital universitario

Fundamento La utilizacion de especialidades farmaceuticas genericas (EFG) ha emergido en los ultimos anos como una herramienta necesaria para el control del gasto sanitario. Nuestro objetivo fue conocer su perfil de utilizacion al alta de pacientes ingresados en un hospital universitario. Material Y Metodo Analisis de 256 informes, recogidos al azar, correspondientes a 8 servicios diferentes, durante junio y julio del 2000. Resultados De 1.233 prescripciones existia alguna EFG para 220 (18%), pero solo se indico en el 2,2% de los casos. El coste de los medicamentos con generico fue de 707.521 pts., que podria haber sido de 505.865 pts. calculando el precio promedio de los genericos posibles o de 479.672 pts. considerando los mas economicos. Conclusiones Existen EFG para una proporcion no desdenable de los medicamentos que se prescriben. No obstante, su utilizacion no es una practica habitual de los medicos hospitalarios.

Capacidad diagnóstica del antígeno carcinoembrionario

INTRODUCTION There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal. OBJETIVES To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination. METHODS A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007. RESULTS We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 €. CONCLUSIONS Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost.Introduction There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal.

OriginalCapacidad diagnóstica del antígeno carcinoembrionarioDiagnostic capability of carcinoembryonic antigen elevation

INTRODUCTION There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal. OBJETIVES To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination. METHODS A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007. RESULTS We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 €. CONCLUSIONS Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost.Introduction There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal.

Acceso telefónico para sordos al Sistema de Emergencias Sanitarias 061

La demanda de asistencia y el acceso inicial a los sistemas de atencion in situ para emergencias sanitarias se produce mediante la comunicacion telefonica a traves de un numero de marcacion rapida como es el 061. Este numero y el acceso al sistema de emergencias son comunes para el territorio nacional. En otros paises existen sistemas similares que usan el mismo o diferente numero (911, 112) de marcacion rapida. El acceso se realiza por via telefonica y mediante lenguaje oral. Como es obvio, la poblacion con deficit auditivo presenta una barrera infranqueable para acceder a tal sistema. El problema se plantea, sin solucion por el momento, en todos los paises de nuestro entorno 1 . Se han expresado protestas por la existencia de barreras de comunicacion para el acceso de la poblacion con deficiencia auditiva a los servicios de salud 1-3 . Un modo de comunicacion telematica muy extendido entre la poblacion sorda es el fax. Esta comunicacion se realiza mediante lenguaje escrito y con gran componente iconografico, por lo que resulta mas facilmente comprensible y asimilable 2 . Otras tecnologias mas recientes (short message systems de telefonia movil y correo electronico) no se encuentran todavia tan ampliamente extendidas y presentan complicaciones especificas de uso. De hecho, entre la poblacion con discapacidad auditiva espanola, el 70% posee fax, frente al 10% que cuenta con telefono movil de texto o un infimo porcentaje que tiene acceso a Internet. En este trabajo se ha desarrollado y validado un protocolo basado en la comunicacion grafica y el empleo del fax que permite a las personas con discapacidad auditiva el acceso al Sistema de Emergencias Sanitarias 061. El protocolo incluye un cuestionario grafico, donde el paciente indica al 061 el problema que presenta, y una respuesta que el 061 devuelve al paciente a modo de acuse de recibo. Esta respuesta puede incluir, tambien, unos consejos sanitarios que se pueden aplicar hasta que llega el recurso sanitario asignado.

Estudio de coste-efectividad del empleo de somatostatina para la disminución de pancreatitis agudas post-CPRE

Objetivos Estudios recientes demuestran que la inyeccion intravenosa de somatostatina previa a la practica de una CPRE se acompana de una significativa reduccion de la tasa de pancreatitis aguda post-CPRE. Ante la falta de datos en nuestro medio, hemos querido estudiar el posible beneficio economico de la administracion de somatostatina, obtenido a traves de la disminucion de los costes debidos a las pancreatitis agudas post-CPRE. Material y Metodo Estudio teorico de los costes directos de la pancreatitis aguda post-CPRE, mediante el metodo del “arbol de decisiones” de Markov. Se comparan los costes del grupo pretratado con administracion intravenosa de 3 mg de somatostatina con respecto al grupo control. Se aceptan unas tasas de pancreatitis post-CPRE del 10% en el grupo control y del 3% en grupo con somatostatina. Los costes de los distintos tipos de pancreatitis, sin y con complicaciones y con actuacion quirurgica, se han basado en los pesos por GDR aplicados por el Ministerio de Sanidad y en el Contrato-programa del Servicio Navarro de Salud para 1999. Se ha efectuado un analisis de sensibilidad para precisar a partir de que tasa de pancreatitis post-CPRE se obtendria un beneficio economico en el grupo pretratado con somatostatina. Resultados El coste medio teorico por exploracion fue de 121.640 pesetas para el grupo control y de 105.539 pesetas para los tratados con somatostatina, con un ahorro por caso del 13,26% (16.101 pesetas). El analisis de sensibilidad demuestra que con la premedicacion se obtiene un beneficio economico a partir de tasas de pancreatitis del 4,2% en el grupo control. Conclusiones Con independencia del beneficio clinico que significa la reduccion de pancreatitis post-CPRE, la administracion de somatostatina supone un ahorro de 16.101 pesetas por paciente. Aceptando que la tasa de pancreatitis en el grupo tratado se reduce de manera proporcional, el analisis de sensibilidad pone de manifiesto que con la premedicacion se obtiene un beneficio economico a partir de tasas de pancreatitis del 4,2% en el grupo control.

Estudio de la albúmina sérica y del índice de masa corporal como marcadores nutricionales en pacientes en hemodiálisis

BACKGROUND Protein calorie malnutrition as well as systemic inflammation and metabolic disorders are common among patients with chronic renal failure undergoing renal replacement therapy (haemodialysis), which contributes to its morbidity and mortality. AIMS The aims of this work was to evaluate the nutritional status of patients in a hemodialysis treatment through the assessment of biochemical parameters nutritional as albumin, and anthropometric parameters of body mass index during ten years of follow up. METHODS In this work has been followed 90 patients of both sexes with chronic kidney disease who were treated with hemodialysis regularly on our unit for ten years. All patients were conducted quarterly measurements of plasma albumin (Alb), and other biochemical determinations, and anthropometric measurements of height, weight and body mass index calculated by the formula weight/height², grouped n BMI < 23 kg/m² and albumin levels <3.8 g/dl according to the consensus of the panel of experts of the International Society for renal Nutrition and metabolism. RESULTS During the 10 years all patients showed a significant decline in the biochemical parameters and the albumin, change in BMI does not presented significant changes in relation to malnutrition. CONCLUSIONS Malnutrition in patients on dialysis is a fact patent, BMI does not correspond with the biochemical parameters were observed, for what nutritional impairment in these patients is mainly expressed by serum albumin.

Influye el posible cansancio del endoscopista en la frecuencia de colonoscopias incompletas y de las lesiones polipoideas diagnosticadas

INTRODUCTION Nowadays, the possible effect of endoscopist fatigue on the results of colonoscopies is under discussion. We aimed to analyze possible differences in cecal intubation and the polyp and adenoma detection rate, depending on whether colonoscopies were performed at the beginning or at the end of the daily endoscopy session and to analyze the influence of the queue position on the detection rate. PATIENTS AND METHODS A retrospective study was performed with 1,000 ambulatory and consecutive colonoscopies, divided into 2 groups: «early» and «late» procedures. A total of 95 colonoscopies were excluded due to poor colon cleansing. After confirming that patient characteristics were homogenous in the two groups, we compared the frequency of complete colonoscopies and the polyp and adenoma detection rate. Possible differences between the 2 groups in the polyp detection rate according to the colonoscopy schedule were analyzed. RESULTS The overall polyp and adenoma detection rates were 44.2 and 30.5%, respectively, with no significant differences among 13 different endoscopists; polyps: p = 0.21; adenomas: p=0.63. No significant differences were found between the «early group» (n= 532) and the «late group» (n = 373) in the rates of complete colonoscopies [97.2 vs 99.4% (p=0.92)], the polyp detection rate [45.9 vs 41.8% (p=0.23)], the adenoma detection rate [30.8 vs 30% (p=0.80)] or the serrated adenoma rate [2.1% vs 1.6% (p=0.62)]. The lesion detection rate did not vary in relation to the «queue position»: polyps [p = 0.60, and adenomas: p = 0.83. CONCLUSIONS In our series, endoscopist fatigue at the end of the day had no influence on the complete colonoscopy rate or on the polyp and adenoma detection rate. There were no differences in the number of polypoid lesions detected according to the timing of the colonoscopy schedule.

Estudio del síndrome metabólico y de la obesidad en pacientes en hemodiálisis

INTRODUCTION The metabolic syndrome (MS) consists of a set of clinical and biochemical changes. It is very common among chronic hemodialysis patients, being the leading cause of death in these patients, 44% of all patients undergoing this therapy. AIMS The aim of this study was to investigate the prevalence of MS and risk factors associated with its development, as well as the prevalence of obesity in HD patients. METHODS This study has followed 90 patients of both sexes with chronic renal failure (CRF) who were treated with hemodialysis periodically in our unit for ten years. All patients were performed quarterly measurements of plasma albumin (A1b) and other biochemical analysis; besides, they underwent some anthropometric measurements like weight, height and body mass index (BMI). This was calculated using weight / size2 formula and grouped in BMI values according to WHO criteria. The data concerning hypertension and glucose were also considered. RESULTS The prevalence of MS was 25% and obesity was presented as follows: 45% with type I overweight; 30.8% with type II overweight and 12 patients (2%) were obese. Being statistically significant as risk factors, BMI, overweight, triglycerides, total cholesterol, HDL cholesterol as well as hypertension and elevated glucose levels were obtained. CONCLUSIONS The metabolic syndrome compromises the patient survival causing a high prevalence in these patients. The principal risk factors in MS are monitoring weight, BMI, triglycerides, HDL cholesterol, hypertension and diabetes.INTRODUCTION The metabolic syndrome (MS) consists of a set of clinical and biochemical changes. It is very common among chronic hemodialysis patients, being the leading cause of death in these patients, 44% of all patients undergoing this therapy. AIMS The aim of this study was to investigate the prevalence of MS and risk factors associated with its development, as well as the prevalence of obesity in HD patients. METHODS This study has followed 90 patients of both sexes with chronic renal failure (CRF) who were treated with hemodialysis periodically in our unit for ten years. All patients were performed quarterly measurements of plasma albumin (A1b) and other biochemical analysis; besides, they underwent some anthropometric measurements like weight, height and body mass index (BMI). This was calculated using weight / size2 formula and grouped in BMI values according to WHO criteria. The data concerning hypertension and glucose were also considered. RESULTS The prevalence of MS was 25% and obesity was presented as follows: 45% with type I overweight; 30.8% with type II overweight and 12 patients (2%) were obese. Being statistically significant as risk factors, BMI, overweight, triglycerides, total cholesterol, HDL cholesterol as well as hypertension and elevated glucose levels were obtained. CONCLUSIONS The metabolic syndrome compromises the patient survival causing a high prevalence in these patients. The principal risk factors in MS are monitoring weight, BMI, triglycerides, HDL cholesterol, hypertension and diabetes.

Risk factors for intracranial lesions and mortality in older patients with mild traumatic brain injuries

ABSTRACT Primary Objective: To identify risk factors for intracerebral lesion (ICL) in older adults with mild traumatic brain injury (MTBI) and evaluate the influence of comorbidities on outcomes. Research Design: Prospective cohort study. Methods and Procedures: Information was gathered on clinical history/examination, cranial computed tomography, admission Glasgow Coma Scale (GCS) score, analytical and coagulation findings, and mortality at 1 week post-discharge. Bivariate and multivariate logistic regression analyses were performed, calculating odds ratios for ICL with 95% confidence interval. P < 0.05 was considered significant. Main Outcomes and Results: Data were analyzed on 504 patients with mean±SD age of 79.37 ± 8.06 years. Multivariate analysis showed that traffic accident, GCS score of 14/15, transient consciousness loss, nausea, and receipt of antiplatelets were predictors of ICL, while SRRI and/or benzodiazepine intake was a protective factor. A score was assigned to patients by rounding OR values, and a score ≥1 indicated moderate/high risk of ICL. Conclusions: MTBI management should be distinct in over-60 year-olds, who may not present typical symptoms, with frequent comorbidities. Knowledge of risk factors for post-MTBI ICL, associated with higher mortality, is important to support clinical decision-making. Further research is warranted to verify our novel finding that benzodiazepines and/or SSRI inhibitors may act as neuroprotectors.