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Resumen Introduccion y objetivos El objetivo es determinar la frecuencia de uso y la disponibilidad en funcion del tiempo de las citas electronicas recogidas en R evista E spanola de C ardiologia y otras tres revistas biomedicas espanolas, asi como los factores que pueden influir en la disponibilidad y la recuperabilidad de los enlaces. Metodos Estudio descriptivo transversal que incluyo todas las citas de los trabajos publicados en el primer numero del ano de las revistas seleccionadas en los anos pares desde 2002 hasta 2012. Se recogieron datos de revista, publicacion, citas y enlaces. Las variables resultado fueron: porcentaje de articulos con al menos una cita electronica, porcentaje de cita electronica respecto al total de citas y porcentaje de accesibilidad y recuperabilidad de los enlaces. Resultados Se incluyeron 377 trabajos, de los que 73 (19,4%; intervalo de confianza del 95%, 15,2-23,5) incluyeron al menos una cita electronica, y 7.077 citas bibliograficas, de las que 164 (2,3%; intervalo de confianza del 95%, 2,0-2,7) fueron citas electronicas. R evista E spanola de C ardiologia incluyo 17 (15,2%) y 38 (1,3%) respectivamente. La frecuencia de uso se incremento significativamente con el tiempo (tendencia lineal, p Conclusiones Se esta haciendo un uso cada vez mas frecuente de citas electronicas en ciertas revistas biomedicas espanolas. La disponibilidad se pierde con el tiempo, y la probabilidad de recuperarla se relaciona con la informacion adicional.

Cocaine use has risen exponentially in all European countries, particularly Spain and the United Kingdom, with a prevalence of users per capita very similar to that of the United States.1 The fact that cocaine use has become more widespread among Spanish youth is a matter of major concern.2 As a result, the number of users treated in hospital emergency rooms for medical problems resulting from acute intoxication,3 such as chest pain,4 has increased. The extent of the problem in terms of chronic effects, particularly cardiovascular effects,5 remains to be seen; these effects are likely to be associated with coronary disease.6,7 We have read with interest the consensus document on the use of beta-blockers written by a task force of the European Society of Cardiology and published in the Revista Espanola de Cardiologia,8 and would like to point out that no mention was made that these medications are contraindicated when an acute cardiac condition coexists with cocaine intoxication or overdose. In the case of acute coronary syndrome associated with cocaine use, vasospasms worsen in hypertensive patients treated with propranolol.9 Labetalol and esmolol are not effective, and alpha-adrenergic stimulation may actually exacerbate vasospasm and hypertension.10,11 Hence, benzodiazepines, nitroglycerin, and aspirin are recommended as first-line drugs. Alphaadrenergic receptors (phentolamine) and calcium blockers (verapamil) would be used for second-line hypertension therapy. In cases of ST segment elevation, primary percutaneous coronary angioplasty is recommended over fibrinolysis, which has a higher incidence of coronary vasospasm and a greater risk of bleeding in other organs.4 As toxicologists and emergency room physicians, we consider that the attending physician should take this contraindication into consideration not only in patients first seen for an acute coronary syndrome, but also in patients whose clinical condition