La docencia sobre cronicidad en las facultades de Medicina: una revisión de la situación actual / Teaching about chronicity in medical schools — A review of the current situation

In recent decades, progressive population aging in developed countries has led to a significant increase in the number of people with at least one chronic medical condition. As a result, acquiring knowledge about chronicity in medical school is key for physicians to be able to provide proper management for these patients. However, the presence of chronicity in educational curricula is scarce and highly variable. On the one hand, this work consisted of a review of the educational programs of the main medical schools on each continent with the aim of identifying whether they included chronicity and, on the other, a literature review focused on identifying educational projects in the field of chronicity. The presence of chronicity in most medical schools’ curricula is marginal and only a few universities include specific skills or competences linked to chronicity. In most cases, this topic appears as a global, cross-curricular competence that students are supposed to acquire over the course of their entire education. The literature review retrieved 21 articles on innovative teaching projects on chronicity. Direct contact with chronic patients, most times as “health mentors,” the role of the student as a teacher, and continuous evaluation and feedback from all participants are the main characteristics of the projects analyzed. Some previously published experiences support the usefulness of innovative methodologies for better approaching this capital field in current medical practice. Despite the current situation in which chronic patients consume most healthcare resources, the presence of chronicity in medical schools is marginal. However, a literature review did identify some useful experiences for improving education on chronicity in medical schools. Medical schools should change their academic curricula and redirect them towards providing students all the necessary tools for improving their knowledge on chronicity (AU)

En las últimas décadas, el progresivo envejecimiento de la población en los países desarrollados ha provocado un aumento significativo del número de personas con al menos una enfermedad crónica. Como consecuencia, es fundamental que la formación pregrado en Medicina aporte conocimientos sobre la cronicidad, de forma que los médicos puedan proporcionar un manejo adecuado a estos pacientes. A pesar de ello, la presencia de la cronicidad en los currículos formativos de las facultades de Medicina es escasa y muy variable. Este trabajo consistió, por un lado, en una revisión de los programas formativos de las principales facultades de Medicina de cada continente, con el objetivo de identificar si incluían aspectos relacionados con la cronicidad y, por otro, en una revisión bibliográfica enfocada a identificar proyectos educativos en el campo de la cronicidad. La presencia de la cronicidad en los planes de estudio de la mayoría de las facultades de Medicina es marginal y solo unas pocas universidades incluyen habilidades o competencias específicas vinculadas a este campo. En la mayoría de los casos en los que sí aparece, este tema se refleja como una competencia global y transversal que los estudiantes deben adquirir a lo largo de toda su formación. La revisión bibliográfica identificó 21 artículos sobre proyectos docentes innovadores sobre cronicidad. Las principales características de los proyectos analizados son: el contacto directo con pacientes crónicos, la mayoría de las veces como «mentores de salud», el papel del estudiante como profesor y la evaluación y retroalimentación continuas de todos los participantes. Algunas experiencias previamente publicadas avalan la utilidad de metodologías innovadoras para una mejora en el abordaje de este campo en la práctica médica diaria. A pesar de la situación actual, en la que los pacientes crónicos consumen la mayor parte de los recursos sanitarios, la presencia de la cronicidad en las facultades de Medicina es marginal (AU)

Teaching about chronicity in medical schools - A review of the current situation.

In recent decades, progressive population aging in developed countries has led to a significant increase in the number of people with at least one chronic medical condition. As a result, acquiring knowledge about chronicity in medical school is key for physicians to be able to provide proper management for these patients. However, the presence of chronicity in educational curricula is scarce and highly variable. On the one hand, this work consisted of a review of the educational programs of the main medical schools on each continent with the aim of identifying whether they included chronicity and, on the other, a literature review focused on identifying educational projects in the field of chronicity. The presence of chronicity in most medical schools' curricula is marginal and only a few universities include specific skills or competences linked to chronicity. In most cases, this topic appears as a global, cross-curricular competence that students are supposed to acquire over the course of their entire education. The literature review retrieved 21 articles on innovative teaching projects on chronicity. Direct contact with chronic patients, most times as "health mentors," the role of the student as a teacher, and continuous evaluation and feedback from all participants are the main characteristics of the projects analyzed. Some previously published experiences support the usefulness of innovative methodologies for better approaching this capital field in current medical practice. Despite the current situation in which chronic patients consume most healthcare resources, the presence of chronicity in medical schools is marginal. However, a literature review did identify some useful experiences for improving education on chronicity in medical schools. Medical schools should change their academic curricula and redirect them towards providing students all the necessary tools for improving their knowledge on chronicity.

Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. Nonavasc Registry.

OBJECTIVES: To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF). DESIGN: Prospective, multicenter cohort study. SETTING: Internal medicine departments in Spain. PARTICIPANTS: Inpatients >75 years with NVAF. MEASUREMENTS: We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0-1 point), low (2-4 points), moderate (5-8 points) and high (9-12 points). We also conducted a 1-year follow-up. RESULTS: We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p<0.001). The CONUT score (HR, 1.076; 95%CI 1.009-1.148; p=0.025), the Charlson index (HR, 1.080; 95%CI 1.017-1.148; p=0.013) and the presence of pressure ulcers (HR, 1.700; 95%CI 1.028-2.810; p=0.039) were independently associated with increased mortality at one year of follow-up. The prescription of oral anticoagulants at discharge was associated with lower mortality (HR, 0.440; 95%CI 0.304-0.638; p<0.001). CONCLUSIONS: More than a third of elderly patients hospitalized with NVAF have a moderate to high nutritional risk. These patients have greater mortality at the end of one year.

Réplica a «Tratamiento de la hiperuricemia asintomática» / Reply to «Treatment of asymptomatic hyperuricaemia»

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La ecografía en el diagnóstico de la hiperuricemia asintomática y la gota / Ultrasound in the diagnosis of asymptomatic hyperuricaemia and gout

El aumento de la concentración sérica de uratos (hiperuricemia, mayor o igual a 7,0mg/dL) ocasiona cristales que promueven inflamación y lesión articular. La ecografía puede poner de manifiesto estos depósitos de urato. Su presencia obliga a considerar que un paciente con hiperuricemia en realidad padece gota asintomática, y que un enfermo con gota sin tofos subcutáneos puede tener gota tofácea. La información que ofrece la ecografía (signo del «doble contorno» y de concreciones hiperecogénicas simulando nubes) posibilita una clasificación de la hiperuricemia y de la gota más precisas. Además, esta información puede dar lugar a modificaciones relevantes en cuanto al proceder diagnóstico y terapéutico en los enfermos con hiperuricemia y gota (AU)

The increase in serum urate concentrations (hyperuricaemia, ≥7.0mg/dL) creates crystals, which promote inflammation and joint lesions. Ultrasonography can reveal these urate deposits. The presence of crystals suggests that a patient with hyperuricaemia is actually experiencing asymptomatic gout, and that a patient with gout without subcutaneous tophi could experience tophaceous gout. The information offered by ultrasound (double contour sign and hyperechoic concretions mimicking clouds) enables a more specific classification of hyperuricaemia and gout. Additionally, this information can lead to relevant changes in terms of the diagnosis and therapeutic approach for patients with hyperuricaemia and gout (AU)

Ultrasound in the diagnosis of asymptomatic hyperuricaemia and gout. / La ecografía en el diagnóstico de la hiperuricemia asintomática y la gota.

The increase in serum urate concentrations (hyperuricaemia, ≥7.0mg/dL) creates crystals, which promote inflammation and joint lesions. Ultrasonography can reveal these urate deposits. The presence of crystals suggests that a patient with hyperuricaemia is actually experiencing asymptomatic gout, and that a patient with gout without subcutaneous tophi could experience tophaceous gout. The information offered by ultrasound (double contour sign and hyperechoic concretions mimicking clouds) enables a more specific classification of hyperuricaemia and gout. Additionally, this information can lead to relevant changes in terms of the diagnosis and therapeutic approach for patients with hyperuricaemia and gout.

Diagrama de diagnóstico y manejo de la diabetes mellitus tipo 2. Update / Diagram of diagnosis and management of type 2 diabetes mellitus. Update

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Tratamiento antitrombótico en el paciente anciano con fibrilación auricular? / Antithrombotic Treatment in Elderly Patients with Atrial Fibrillation

La fibrilación auricular (FA) en el anciano es una entidad compleja debido al elevado número de comorbilidades frecuentemente asociadas, como las enfermedades cardiovasculares y la enfermedad renal, los trastornos cognitivos, las caídas o la polimedicación. Excepto cuanto esté contraindicada, la anticoagulación es necesaria para la prevención de los eventos tromboembólicos en esta población. Tanto los antagonistas de la vitamina K como los anticoagulantes orales de acción directa (dabigatran, rivaroxaban y apixaban) están indicados en este contexto. En este grupo de edad la función renal debe ser estrechamente vigilada cuando se utilizan estos últimos. En los últimos años se han publicado diferentes guías de práctica clínica sobre el paciente con FA. La mayoría de estas guías realizan recomendaciones específicas sobre las características clínicas y el tratamiento en los pacientes ancianos. En esta actualización se revisan los comentarios específicos sobre las recomendaciones referentes al tratamiento antitrombótico en los pacientes ancianos con FA no valvular (AU)

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF (AU)

Antithrombotic treatment in elderly patients with atrial fibrillation. / Tratamiento antitrombótico en el paciente anciano con fibrilación auricular.

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF.

Timeliness of care and prognosis in patients with lung cancer.

BACKGROUND: Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. AIMS: To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. METHODS: A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. RESULTS: A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. CONCLUSIONS: The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.

Eficacia y seguridad de ezetimiba en unidades de riesgo vascular / Efficacy and safety of ezetimibe in vascular risk units

Objetivos Desconocemos la eficacia hipolipemiante y la seguridad de ezetimiba en monoterapia o combinada con estatinas en atención especializada y condiciones de práctica clínica. Pacientes y métodos Estudio retrospectivo multicéntrico (unidades hospitalarias de medicina interna y endocrinología) de pacientes tratados con ezetimiba durante al menos 12 semanas. Los pacientes fueron incluidos en tres grupos: a) ezetimiba como único hipolipemiante; b) ezetimiba añadida a estatina, y c) ezetimiba combinada de inicio con estatina. La variable principal fue el porcentaje medio de reducción de colesterol de las lipoproteínas de baja densidad (cLDL) en el último análisis disponible respecto al documentado antes de comenzar el tratamiento con ezetimiba. Resultados Incluimos a 217 pacientes (media de edad, 59 años), 61% mujeres. Un 21% padecía diabetes mellitus tipo 2 y el 20% había sufrido un evento cardovascular previo, por lo que el tratamiento hipolipemiante debía satisfacerr objetivos de prevención secundaria. En el subgrupo de monoterapia (n=92; tratamiento medio, 41 semanas) el cLDL descendió un 28% (p<0,001). En el subgrupo de ezetimiba añadido a estatinas (n=94; tratamiento medio, 73 semanas) el cLDL disminuyó un 34% (p<0,001). En el subgrupo ezetimiba más estatina de inicio (n=31; tratamiento medio, 118 semanas) el cLDL descendió un 53% (p<0,001). En total, un 64% de los pacientes alcanzó el objetivo terapéutico propuesto por el Adult Treatment Panel III (ATPIII) para cLDL. En los pacientes con bajo riesgo (cLDL<160 mg/dl), riesgo moderado (cLDL<130 mg/dl) y riesgo alto-muy alto (cLDL<100-70 mg/dl), los enfermos en objetivo terapéutico fueron el 81%, el 64% y el 44%, respectivamente. Conclusiones En condiciones de práctica clínica habitual, ezetimiba resulta eficaz y segura para reducir el cLDL, permitiendo alcanzar los objetivos terapéuticos propuestos por ATPIII en un elevado número de pacientes, especialmente si se combina con estatinas (AU)

Objectives. This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. Patients and methods. A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. Results. A total of 217 patients (mean age 59years; 37% ¡Ý65years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n=92; mean 41weeks) included: decrease of LDLc of 28% (P<.001). In the group where ezetimibe was added on to different ongoing statins (n=94, mean 73weeks), mean changes was as follows: LDLc ¨C34%, significant change as compared to monotherapy (P<.001). In the group with initial coadministration of ezetimibe with different statins (n=31; mean 118weeks), mean change included: LDLc ¨C53% (P<.001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc<160mg/dL), moderate risk (LDLc<130mg/dL) and high-very high risk (LDLc<100-70mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. Conclusions. Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins(AU)

[Efficacy and safety of ezetimibe in vascular risk units]. / Eficacia y seguridad de ezetimiba en unidades de riesgo vascular.

OBJECTIVES: This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. PATIENTS AND METHODS: A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12 weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. RESULTS: A total of 217 patients (mean age 59 years; 37% ≥65 years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n = 92; mean 41 weeks) included: decrease of LDLc of 28% (P <.001). In the group where ezetimibe was added on to different ongoing statins (n = 94, mean 73 weeks), mean changes was as follows: LDLc -34%, significant change as compared to monotherapy (P < .001). In the group with initial coadministration of ezetimibe with different statins (n = 31; mean 118 weeks), mean change included: LDLc -53% (P < .001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc < 160 mg/dL), moderate risk (LDLc < 130 mg/dL) and high-very high risk (LDLc < 100-70 mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. CONCLUSIONS: Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins.

Effect of delays on survival in patients with lung cancer

BACKGROUND: The effect on survival of delays in the consultation, diagnostic and treatment processes of lung cancer (LC) is still under debate. The objective of our study was to analyse these time delays and their possible effect on survival. METHODS: A retrospective study has been performed on all patients in our health area diagnosed with LC (confirmed by cytohistology) over 3 years. The delay in specialist consultation (time between start of symptoms and the first consultation with a specialist), hospital delay (time between first consultation and start of treatment) and overall delay (the sum of the previous two delays) were analysed. The influence of each of these delays was calculated using Cox regression, adjusted for other factors. RESULTS: A total of 415 patients were included. Of these, 92.5% were male and 75.4% were in stages III-B or IV. The overall delay gave a mean of 123.6 days, the delay in consulting a specialist 82.1 days and the delay in hospitalisation was 41.4 days. A greater overall delay or greater hospital delay was associated with longer survival. No relationship was observed between the specialist consultation delay and survival. CONCLUSIONS: Globally analysing all the cases and all the stages with LC, it is seen that longer delays are associated with longer survival. This probably reflects the fact that patients with more symptoms are treated more rapidly (AU)

Sirius: a web-based system for retinal image analysis.

PURPOSE: Retinal image analysis can lead to early detection of several pathologies such as hypertension or diabetes. Screening processes require the evaluation of a high amount of visual data and, usually, the collaboration between different experts and different health care centers. These usual routines demand new fast and automatic solutions to deal with these situations. This work introduces Sirius (System for the Integration of Retinal Images Understanding Services), a web-based system for image analysis in the retinal imaging field. METHODS: Sirius provides a framework for ophthalmologists or other experts in the field to collaboratively work using retinal image-based applications in a distributed, fast and reliable environment. Sirius consists of three main components: the web client that users interact with, the web application server that processes all client requests and the service module that performs the image processing tasks. In this work, we present a service for the analysis of retinal microcirculation using a semi-automatic methodology for the computation of the arteriolar-to-venular ratio (AVR). RESULTS: Sirius has been evaluated in different real environments, involving health care systems, to test its performance. First, the AVR service was validated in terms of precision and efficiency and then, the framework was evaluated in different real scenarios of medical centers. CONCLUSIONS: Sirius is a web-based application providing a fast and reliable work environment for retinal experts. The system allows the sharing of images and processed results between remote computers and provides automated methods to diminish inter-expert variability in the analysis of the images.

[Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases]. / Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos.

INTRODUCTION: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. AIMS: To know the clinical characteristics in the presentation of the lung cancer in our health care area. MATERIAL AND METHODS: All of the incident lung cancer cases for 3 years (January 1, 1997 to December 31, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. RESULTS: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. CONCLUSIONS: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis.

Motivo de consulta en el diagnóstico de cáncer de pulmón. Revisión de 481 casos / Reason for a medical visit in the diagnosis of lung cancer. A review of 481 cases

Introducción: El cáncer de pulmón es la causa más frecuente de muerte por cáncer en el mundo. Su presentación clínica corresponde habitualmente a estadios avanzados. Desde hace años persiste la controversia sobre la indicación de programas de cribado para el diagnóstico en fases tempranas. Objetivos: Conocer las características clínicas en la presentación del cáncer de pulmón en nuestra área sanitaria. Material y métodos: Se recogieron retrospectivamente todos los casos incidentes de cancer de pulmón durante 3 años (1 de enero de 1997 a 31 de diciembre de 1999), de pacientes con residencia habitual en el área sanitaria de Santiago de Compostela, a partir de la información disponible en el servicio de codificación. El tipo histológico se clasificó según la clasificación de la Organización Mundial de la Salud. La fecha de fallecimiento se obtuvo de la historia clínica del paciente, el registro de mortalidad o de llamadas telefónicas al domicilio del paciente. El resto de la información se obtuvo de la historia clínica del paciente y del servicio de anatomía patológica. Resultados: Se diagnosticaron 481 casos de cáncer de pulmón (tasa bruta de incidencia de 41,79 por 100.000 habitantes y año). La mediana de edad fue 66,9 años (rango intercuartil 60,5-74,4), siendo el 92,77% varones. El 94,1% correspondía a fumadores o exfumadores. Los síntomas más prevalentes como motivo de consulta fueron el síndrome general (20%), el dolor torácico (19%) y la hemoptisis (17%). Existe un grupo de pacientes (56), fundamentalmente varones, de diagnóstico incidental. Conclusiones: La incidencia de cáncer de pulmón parece elevada en nuestra área sanitaria. El paciente tipo con cáncer de pulmón en esta área sanitaria corresponde a un varón de 67 años, fumador, diagnosticado en estadios avanzados, que consulta por síndrome general y/o dolor torácico. Algunos de los síntomas se presentan con diferencias significativas entre sexos. Asimismo, hay diferencias entre histologías, siendo llamativa la elevada frecuencia de dolor torácico en adenocarcinoma, aunque también es la primera causa de consulta en microcítico. Por el contrario, la hemoptisis es el motivo de consulta más frecuente en epidermoide y el síndrome general en el tipo células grandes o con diagnóstico clínico-radiológico (AU)

Introduction: Lung cancer is the most frequent cancer death related cause in the world. Its clinical presentation usually corresponds to advanced stages. The indication of screening programs for the diagnosis in early phases has been debated for years. Aims: To know the clinical characteristics in the presentation of the lung cancer in our health care area. Material and methods: All of the incident lung cancer cases for 3 years (January l, 1997 to December 3l, 1999) among those patients with usual residence in the Santiago de Compostela health care area were retrospectively collected from the available information in the Codification Service. The histological type was graded according to the World Health Organization classification. Date of death was obtained from the patient's clinical history, mortality record, or telephonic calls to the patient's home. The rest of the information was obtained from the clinical records of the patient and Pathology Service. Results: Four-hundred and eighty-one lung cancer cases were diagnosed (incident gross rate of 41.79 per 100,000 inhabitants and year). Median age was 66.9 years (interquartile range 60.5-74.4), 92.77% being males and 94.1% corresponding to smokers or former smokers. The most prevalent symptoms motivating the visit were general syndrome (20%), thoracic pain (19%) and hemoptisis (17%). A group of patients (56), fundamentally males, had an incidental diagnosis. Conclusions: The incidence of lung cancer seems to be high in our health care area. The standard patient with lung cancer in this health care area is a 67-year-old, male, who smokes, diagnosed in advanced stages, who consults due to a general syndrome and/or chest pain. Some of the symptoms appear with significant gender differences. Likewise, there are differences between histologies, the high frequency of chest pain in adenocarcinoma being outstanding, although it is also the first cause for consultation in small cell lung cancer. On the contrary, hemoptisis, the most frequent consultation cause in squamous cell carcinoma and the general syndrome in the big cells type or with clinical-radiological diagnosis (AU)

[Do we define the COPD correctly?]. / Definimos correctamente la EPOC?

Chronic obstructive pulmonary disease (COPD) is a very common disease which prevalence is increasing and in a nearly future it will represent a socio-sanitary problem. This article s objective is to make a reflexion about the concept COPD, for the physicians contribute to their divulgation to the population and very specially to help to the tobacco desertion. Besides we want to reveal that the term has been well-finished due to the advance in the knowledge of aetiology, physiopathology, and radiology techniques. Although, we think that the acronym still includes entities with a very different features. We hope to clarify this concept in the future, establishing different phenotypes and mainly with molecular biology.

¿Definimos correctamente la EPOC? / Do we define the COPD correctly?

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad muy frecuente, cuya prevalencia sigue aumentando y que en un futuro próximo supondrá un problema socio-sanitario. El propósito de este artículo es hacer una reflexión sobre el concepto EPOC, para contribuir por parte de los médicos a su divulgación a la población y muy concretamente al abandono del hábito tabáquico. Por otro lado también queremos hacer constar, que debido a los avances en el conocimiento etiológico, fisiopatológico, técnicas de imagen etc, el término se ha perfilado de forma muy positiva. No obstante creemos que el acrónimo todavía incluye entidades con perfiles muy diferentes. Esperemos que en el futuro, estableciendo distintos fenotipos y sobre todo con ayuda de la biología molecular podamos clarificar más este concepto

Chronic obstructive pulmonary disease (COPD) is a very common disease which prevalence is increasing and in a nearly future it will represent a socio-sanitary problem. This article’s objective is to make are flexion about the concept COPD, for the physicians contribute to their divulgation to the population and very specially to help to the tobacco desertion. Besides we want to reveal that the term has been well-finished due to the advance in the knowledge of aetiology, physiopathology, andradiology techniques. Although, we think that the acronym still includes entities with a very different features. We hope to clarify this concept in the future, establishing different phenotypes and mainly with molecular biology