RESUMEN
El paciente que ha sufrido un infarto de miocardio es habitualmente atendido, casi en exclusividad, por el cardiólogo, limitándose el médico de familia a controlar algunos factores de riesgo y posibilitar la renovación de la medicación prescrita. Sin embargo el médico de familia puede y debe tomar un papel activo, garantizando la continuidad de cuidados y estratificando a los postinfartados según su nivel de riesgo. Los pacientes con mejor pronóstico deben ser incluidos en un Programa de Rehabilitación Cardíaca (PRC) extrahospitalario, bajo control del médico de familia y se deben emplear las medidas de prevención secundaria que hayan demostrado su eficacia en ensayos clínicos controlados. Cuando el pronóstico es moderado-severo se debe colaborar con el cardiólogo en la prevención secundaria y en el desarrollo de la fase de mantenimiento del PRC. En todos los casos la educación sanitaria constituye un elemento básico e ineludible de la Atención Primaria (AU)
Asunto(s)
Humanos , Infarto del Miocardio/complicaciones , Atención Progresiva al Paciente , Médicos de Familia , PronósticoRESUMEN
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.
