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Ibrahim-Achi, M.A. Pérez-Carrillo, M. Expósito-Rodriguez, G. Burillo-Putze" "autores" => array:4 [ 0 => array:3 [ "nombre" => "D." "apellidos" => "Ibrahim-Achi" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "M.A." "apellidos" => "Pérez-Carrillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Expósito-Rodriguez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "G." "apellidos" => "Burillo-Putze" "email" => array:1 [ 0 => "gburillo@telefonica.net" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicaciones agudas en hospitales comarcales" ] ] "textoCompleto" => "The article by Baeza et al.<a class="elsevierStyleCrossRef" href="#bib0050">1</a> provides, in our opinion, an important overview of acute poisonings. Most published series in Spain are currently based on data from patients with poisonings treated only in tertiary or reference hospitals, located in large cities, generally the capitals of provinces or of autonomous regions. The study by Baeza et al., in contrast, provides epidemiological data on emergency care in hospital centers at lower care levels, one of which is also a characteristic summer tourist area, with its expected seasonal fluctuations, but not previously.<a class="elsevierStyleCrossRef" href="#bib0050">1</a> Given that it is difficult even for reference hospitals to find emergency care professionals interested in clinical toxicology and involved in epidemiological research, finding them in smaller hospitals with over a period of 5 years is exceptionally commendable.<a class="elsevierStyleCrossRef" href="#bib0055">2</a>In the evolution of the incidence of cases, it is noteworthy how the poisoning rate practically triples in the centers with a significantly lower population coverage, compared with urban hospitals where the poisoning rate remained virtually constant over the 5 years analyzed despite a 10% increase in the number of emergencies treated. The authors do not have an explanation for this difference, which could be due to the type of toxic (alcohol) responsible for the Emergency Department visit.Moreover, there was a notable rate of poisoning in individuals older than 75 years, with differences in the reasons behind the poisoning according to sex, but different to those of other series, where more suicidal poisonings and those resulting in death occurred in this age group.<a class="elsevierStyleCrossRef" href="#bib0060">3</a> With an increasingly aging Spanish population with more and more geriatric emergencies,<a class="elsevierStyleCrossRef" href="#bib0065">4</a> this is another epidemiological element to consider in future epidemiological studies, and therefore for prevention.<a class="elsevierStyleCrossRef" href="#bib0070">5</a>In terms of the toxic subtances responsible for poisonings, there is a scarcity of cases related to agricultural products, despite the study's suburban-rural setting, as well as few poisonings due to paracetamol. In contrast, there was a nonnegligible number of cases due to anticoagulants not previously reported and, what is more disconcerting, 109 cases due to opioids, with the inrush (albeit weak) of heroin, which could be undergoing a resurgence in Spain, as it has been clearly happening in other neighboring countries.<a class="elsevierStyleCrossRef" href="#bib0075">6</a> Moreover, it might have been interesting to determine the number of patients diagnosed only by laboratory tests, considering this also leaves out the emerging new psychoactive substances (e.g., mephedrone, synthetic cannabinoids, piperazine), which for now are undetectable in most Spanish tertiary hospitals and in all secondary hospitals.<a class="elsevierStyleCrossRefs" href="#bib0080">7,8</a>The high percentage of patients treated in the first 2hours is probably due to the proximity of healthcare centers to the treated population. As rightly stated by the authors, the precocity of care is related to the high resolutive capacity of the analyzed emergency departments. It is also likely that the relatively high hospital admission rate is due to the reduced availability of beds in observation areas of the emergency department.Lastly, the emergency department can be another tool for the healthcare system, especially in smaller settings and a priori with a closer physician–patient relationship. Prevention programs for frail groups (such as the elderly patients indicated in the series) and strategies to reduce the worrisome alcohol consumption that the study demonstrates can be developed. Initiatives such as that implemented in the autonomous community of Castilla y León have achieved interesting results, although a high degree of commitment is needed from emergency department professionals.<a class="elsevierStyleCrossRef" href="#bib0090">9</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ibrahim-Achi D, Pérez-Carrillo MA, Expósito-Rodriguez M, Burillo-Putze G. Intoxicaciones agudas en hospitales comarcales. Rev Clin Esp. 2020;220:388–389." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de las intoxicaciones agudas asistidas en 3 hospitales del sureste español" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Baeza" 1 => "A. Muñoz-Ortega" 2 => "N. Vela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.07.009" "Revista" => array:3 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2019" "itemHostRev" => array:3 [ "pii" => "S0190962211001228" "estado" => "S300" "issn" => "01909622" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intoxicaciones en España: mirando hacia otro lado" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Puiguriguer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.09.002" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2020" "volumen" => "220" "paginaInicial" => "248" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31635812" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intoxicaciones agudas en pacientes mayores de 65 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Miranda Arto" 1 => "A. Ferrer Dufol" 2 => "F.J. Ruiz Ruiz" 3 => "S. Menao Guillén" 4 => "E. Civeira Murillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4321/s1137-66272014000100011" "Revista" => array:6 [ "tituloSerie" => "An Sist Sanit Navar" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "99" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24871115" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NOVICA: características y evolución en los pacientes que presentan un primer episodio de insuficiencia cardiaca (de novo)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. García Sarasola" 1 => "A. Alquézar Arbé" 2 => "V. Gil" 3 => "F.J. Martín-Sánchez" 4 => "J. Jacob" 5 => "P. Llorens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2019" "volumen" => "469" "paginaInicial" => "469" "paginaFinal" => "476" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolución de la tentativa suicida atendida por los Servicios de Emergencias Médicas de Castilla-La Mancha tras la crisis económica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.J. Celada" 1 => "A. Quiroga-Fernández" 2 => "A. Mohedano-Moriano" 3 => "I. Aliaga Vera" 4 => "C. Fernández Pérez" 5 => "J.L. Martín Conty" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2018" "volumen" => "30" "paginaInicial" => "247" "paginaFinal" => "252" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparación de las urgencias atendidas pordrogas de abuso en dos servicios de urgencias españoles con las atendidas en tres áreas europeas distintas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Miró" 1 => "C. Yates" 2 => "A.M. Dines" 3 => "D.M. Wood" 4 => "P.I. Dargan" 5 => "I. 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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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2.3

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