[Rational use of medications in the treatment of urinary infections]. / Uso racional del medicamento en el tratamiento de infecciones urinarias en el Area de Talavera de la Reina.

OBJECTIVES: MAIN: to encourage the rational use of medication in the treatment of uncomplicated acute cystitis (UAC). SECONDARY: to find the most common germs in our area and their sensitivity to medication, the most common anti-microbials used and patients age, and to evaluate the savings made through a policy of rational use of medication.Design. Retrospective, descriptive, observational study. SETTING: La Solana Health Centre jointly with the biochemistry laboratory of the Talavera Area. PARTICIPANTS: Probabilistic randomised sampling of clinical histories of women between 20 and 80 with episodes of UAC (349 in all) between 01/10/95 and 01/10/00. MEASUREMENTS AND RESULTS: First, the laboratory evaluated 591 urine cultures of complicated/uncomplicated UTI from 01/01/00 to 01/10/00, with study of the germs involved and their sensitivities. 373 positives were isolated: E. coli (78.3%), which had the greatest sensitivity to amoxycillin/clavulanic acid, fosfomycin, nitrofurantoin and cefixime; Proteus (7.2%) and Streptococcus D (5.8%). Second, clinical records were analysed for the following: antibiotics (norfloxacine and cyprofloxacine, the most common); length of treatment (average of 6.52.34 days); age of patient (greater number in under-65s). CONCLUSIONS: E. coli is the most common germ in UTI and is highly sensitive to amoxy/clavulanic acid, nitrofurantoin, fosfomycin and cefixime. Resistance to cyprofloxacine and norfloxacine are starting to be significant. In UAC the three-day model should be encouraged for young women; and 7 days is recommended for the over-65s. More rational use of medication would increase efficacy and suppose a considerable economic saving in our area.

Uso racional del medicamento en el tratamiento de infecciones urinarias en el área de Talavera de la Reina / Rational use of medicines in the treatment of urinary infections

Objetivos. Principal: fomentar el uso racional del medicamento en el tratamiento de cistitis agudas no complicadas (CANC).Secundarios: conocer los gérmenes más frecuentes en nuestra zona y sus sensibilidades, antimicrobianos más utilizados, edad de la paciente y evaluar el ahorro aplicando una política de uso racional del medicamento. Diseño. Estudio observacional descriptivo retrospectivo. Emplazamiento. Centro de Salud La Solana, en colaboración con el Laboratorio de Bioquímica del Área de Talavera. Participantes. Muestreo sistemático probabilístico de historias clínicas de mujeres de entre 20-80 años con episodios de CANC desde el 01 de octubre de 1995 hasta el 1 de octubre de 2000, obteniéndose 349 episodios. Mediciones y resultados. Consta de dos partes: a) evaluación en el laboratorio de 591 urocultivos de infecciones del tracto urinario (ITU) complicadas/no complicadas entre el 1 de enero de 2000 hasta el 1 de octubre del mismo año, estudiando gérmenes implicados y sensibilidades. Se aislaron 373 positivos: Escherichia coli (78,3 por ciento) con mayor sensibilidad a amoxicilina-ácido clavulánico, fosfomicina, nitrofurantoína y cefixima; Proteus (7,2 por ciento), y estreptococo D (5,8 por ciento), y b) análisis en historias clínicas de antibióticos (los más usados, norfloxacino y ciprofloxacino); duración de tratamiento (media de 6,5 ñ 2,34 días); edad de la paciente (mayor número en menores de 65 años).Conclusiones. E. coli es el germen más frecuente en ITU, con alta sensibilidad a amoxicilina-ácido clavulánico, nitrofurantoína, fosfomicina y cefixima. El índice de resistencias a ciprofloxacino y norfloxacino comienza a ser significativo. En las CANC en la mujer joven se debe fomentar la pauta de tres días, recomendando 7 días en mayores de 65 años. Con un uso más racional del medicamento se aumentaría la eficacia y supondría un ahorro económico importante en nuestra área. (AU)

[Bowenoid papulosis. Review of 4 cases in a health center]. / Papulosis bowenoide. Revisión de cuatro casos en un centro de salud.

OBJECTIVE: To check the clinical, histological, evolutionary and therapeutic characteristics of Bowen's Disease. DESIGN: A descriptive study of a crossover type. SETTING: Primary Care and a Dermatology clinic at a Health Centre. PATIENTS: There were 4 adult males, aged between 25 and 31, with pigmented papulosis lesions on their external genitals. Two of them were HIV-positive. MEASUREMENTS AND MAIN RESULTS: Clinical records were used. The diagnosis was confirmed through histological analysis. In all cases the lesions were papulosis, multiple and affecting the external genitals. The patients were clinically controlled until the lesions disappeared. The patients' sexual partners were referred to Gynaecology clinics for examination, but no pathology was found in any of them. CONCLUSIONS: Basic knowledge of Bowen's Disease in Primary Care is important given that it is essential to reach a diagnosis as early as possible, in order to monitor the patient and his partner and so avoid any future complications arising from the pathology's presence, such as tumour processes affecting the uterine cervix. The performance of histological analyses when faced with any suspicious genital lesion must be encouraged, given that this technique is non-aggressive.

[Soft chancroid: 4 clinical cases]. / Chancro blando: cuatro casos clínicos.

OBJECTIVE: The presentation of four clinical cases of chancroid confirmed by means of a culture for Haemophiullus Ducrey and the checking of its clinical and epidemiological characteristics. SETTING: Dermatology Clinic at the "V Centenario" Health Centre, San Sebastián de los Reyes, Madrid. PATIENTS AND OTHER PARTICIPANTS: Four clinical cases collected between 1988 and 1992. They were characterised by the very painful ulcers on the penis which appeared from 10 to 15 days after possible infection. Two of them had been previously treated with penicillin but showed no improvement. MEASUREMENT AND MAIN RESULTS: Clinical records were consulted and the diagnosis was confirmed by means of microbiological culture. Analyses including VDRL and HIV serologies were performed. All the patients were male: the location was the balanopreputial furrow. In two cases the lesion and the secondary adenopathy were single. In the four the general analysis was normal and serology for syphilis negative. Two were HIV positive. All were cured with a single dose of Ceftriaxon. CONCLUSIONS: Even though the chancroid is not common in our field, it must be identifiable so that a proper differential diagnosis of all genital ulcers can be made, with confirmation by means of a culture in a specific medium. The present first line treatment should be in reach of the Public Health System's family doctors and be initiated at once, given that genital ulcers are a risk factor in HIV transmission. Additionally these patients' HIV antibodies should be studied.

[The long-term stability of reactive strips for capillary blood glucose preserved at between 2 and 5 degrees C]. / Estabilidad a largo plazo de las tiras reactivas de glucemia capilar conservadas entre 2 y 5 grados C.

OBJECTIVE: To assess the stability of the reactive strips for capillary glycemia, preserved between 2 and 5 degrees C, and at ambient temperature, during 8 weeks. DESIGN: Transversal descriptive study. SETTING: Health Center "V Centenario" of San Sebastián de los Reyes. PATIENTS AND OTHER PARTICIPANTS: 322 strips were obtained, 31 were underrated because they could not read the orderly days, of the 291 remaining, 159 were kept in the refrigerator between 2 and 5 degrees C, and 132 were kept at ambient temperature, preserved to the light. MEASUREMENTS AND MAIN RESULTS: All the strips were type "BM-test-glycemia 24 hours, and the weeks 1 to 8. At ambient temperature the strips lose the 5% of their basal value, and the 23 and 32% in the first and second weeks respectively (p < 0.001). The strips kept in refrigerator have a rise at 24 hours, with regard to basal value of 7% (p < 0.001). Starting from this moment, a gradual fall of the mean value of the glycemia is produced, significant differences were not found in the second week. After 8 weeks, a mean loss of 10% of the strip value is noticed. CONCLUSIONS: The fall of the strip value, preserved in refrigerator is not clinically very important, an acceptable control of the diabetic patient can be obtained by delayed reading, even 8 weeks, of reactive strips that patients can keep in their refrigerators.