RESUMEN
La tuberculosis continúa siendo la enfermedad infecciosa más importante a nivel mundial, aunque la osteomielitis tuberculosa cada vez se ve con menos frecuencia en los países desarrollados. El diagnóstico de la tuberculosis osteoarticular puede demorarse durante varios meses debido a una baja sospecha clínica. Clínicamente es diferente según la localización, pudiendo presentarse como un absceso frío. Las lesiones radiológicas no son específicas y el diagnóstico de certeza se realiza mediante cultivo en medio específico. El tratamiento sigue siendo un tema en discusión. Presentamos un caso de osteomielitis tuberculosa que debutó como una tumoración abscesificada en tercio superior del brazo derecho de varios meses de evolución, cuyo diagnóstico y tratamiento fue realizado en Atención Primaria. Los médicos debemos pensar siempre en la tuberculosis, ya que es una enfermedad prevalente, transmisible, prevenible y curable (AU)
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Asunto(s)
Masculino , Persona de Mediana Edad , Humanos , Osteomielitis/diagnóstico , Osteomielitis/terapia , Tuberculosis Osteoarticular , Absceso/diagnóstico , Absceso/terapia , Atención Primaria de SaludRESUMEN
OBJECTIVE: To evaluate the Preventive Measures and Health Promotion Programme (PMHPP), in order to find its spread of influence and to identify consequent problems, with the aim of putting in place measures to improve effectiveness. DESIGN: Observational, crossover and retrospective study, using random distribution. SETTING: Primary Care teams (PCT) of Health Area 11, Madrid. PARTICIPANTS: Ten clinical records from each general practitioner/nurse case-load of the 24 PCT in the Area: 1470 clinical records in all. INTERVENTIONS: Clinical auditing carried out in October 1992. MEASUREMENTS AND MAIN RESULTS: Prevalences obtained were: 19.3 +/- 1.03 for AHT, 34.4 +/- 1.24 for tobacco dependency, 17 +/- 0.84 for Hypercholesterolaemia and 20.7 +/- 1.02 for obesity-overweight. All the percentages were higher for patients who attended for the last time in 1992 (p < 0.001), except those concerning breast and cervical cancer screening. CONCLUSIONS: 1. The prevalences obtained from the FR.CV. are close to those theoretically expected. 2. Measures aimed at A.T., tobacco and alcohol were correctly carried out for more than 75% of the patients and were applied to over 50% of the relevant population. 3. Anti-tetanus and anti-rubella vaccinations and breast cancer screening were correctly performed only in just over 25% of cases. 4. Correct compliance with the majority of the measures was higher among users who attended for the last time after the Programme's introduction.
