Plan de Intervención Comunitaria para el manejo de la EPOC estable: protocolo de coordinación asistencial y derivación entre farmacias comunitarias y centros de salud / Community Intervention Plan for the management of stable COPD: protocol for care coordination and referral between community pharmacies and health centres

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad frecuente y progresiva, pero prevenible y tratable. Sin embargo, se han detectado importantes áreas de mejora en su diagnóstico, tratamiento y seguimiento, así como en la adherencia terapéutica. Con el propósito de aumentar la detección precoz de la EPOC y su manejo adecuado en España, se ha diseñado un Plan de intervención comunitaria (PIC) para la colaboración entre farmacias comunitarias y centros de salud de atención primaria. El PIC incluye un procedimiento normalizado de trabajo (PNT), desarrollado por un grupo de profesionales de farmacia comunitaria, medicina de familia, neumología y enfermería de atención primaria. En él se describe el algoritmo que guiará la actuación de los farmacéuticos comunitarios, incluyendo las pruebas y dispositivos para el cribado poblacional de la EPOC, la evaluación de la enfermedad, la adhesión a inhaladores y la detección de errores críticos en el uso de inhaladores entre otros aspectos. El PNT incluye también un formulario para la derivación del paciente al centro de salud correspondiente, donde se llevarán a cabo una serie de acciones preestablecidas en el plan de actuación según el escenario clínico. Además, se propone evaluar la efectividad de la intervención con unos indicadores recogidos en el centro de salud y en farmacia comunitaria. Por último, se recomienda establecer un plan formativo en EPOC para la óptima implementación del plan y una encuesta a pacientes sobre su grado de satisfacción con la intervención. En conclusión, la implantación del PIC podría reducir el infradiagnóstico en EPOC y optimizar el manejo de los pacientes diagnosticados en España, donde los farmacéuticos comunitarios tendrían una función esencial en el abordaje de estos pacientes. (AU)

Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions.

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

Voluntariado radiológico para apoyar un programa de detección precoz del cáncer de mama en Perú: descripción del proyecto, presentación de los primeros resultados e impresiones / Radiology volunteers to support a breast cancer screening program in Peru: description of the project, preliminary results, and impressions

El cáncer de mama es el segundo cáncer más frecuente en las mujeres peruanas. Las limitaciones de los programas nacionales de detección precoz, sobre todo en las regiones rurales, propician que más del 50% de los nuevos casos de cáncer de mama en Perú se diagnostiquen en estadios avanzados. RAD-AID Internacional, en colaboración con una clínica local registrada como organización no gubernamental (CerviCusco), pretende crear una estructura diagnóstica sostenible que mejore el cribado del cáncer de mama en Cuzco. Para ello se ha contado con socios locales, nacionales e internacionales que han colaborado en el análisis de recursos radiológicos, la concienciación de la población, la adquisición de equipamiento, el entrenamiento clínico y las redes de referencia. Nuestros equipos de radiólogos, incluidos en el equipo RAD-AID, han participado en la capacitación ecográfica del personal de CerviCusco, permitiendo una formación adicional a los residentes de radiología gracias a una colaboración internacional reglada.(AU)

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.(AU)

Radiology volunteers to support a breast cancer screening program in Peru: description of the project, preliminary results, and impressions. / Voluntariado radiológico para apoyar un programa de detección precoz del cáncer de mama en Perú: descripción del proyecto, presentación de los primeros resultados e impresiones.

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

Follow-up in head and neck cancer. What the radiologist must know. / Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer.

The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their follow-up, especially when the tumor recurrence is not clinically evident. Radiologically distinguishing post-treatment changes from a tumor recurrence is a challenge due to the anatomical alteration due to surgical techniques and their reconstructions, radiotherapy treatment and chemotherapeutic guidelines. The differential diagnosis must include the possible complications derived from radiotherapy (mucosal necrosis, osteoradionecrosis, vasculopathy, cerebral radionecrosis) and surgery (wound infections, flap necrosis, fistulas,...). A wide knowledge of the expected findings of multimodal treatment and its complications is essential for an accurate diagnosis of tumor recurrence. Finally, choosing the appropriate image study and having a baseline post-treatment study is also relevant for a suitable radiological control.

Is positive oral contrast material necessary for computed tomography in patients with suspected acute abdomen? / Ante la sospecha de abdomen agudo, ¿es necesario el contraste oral positivo en la tomografía computarizada?

The number of computed tomography studies done in emergency departments has increased substantially, and with this increase the controversy about whether positive oral contrast agents are necessary in all patients has also grown. The great image quality provided by multidetector computed tomography scanners, the increase in intraabdominal fat (as a natural element that provides contrast for separating the bowel loops) related with the increased prevalence of obesity in the population, and the potential drawbacks associated with the use of high-density oral contrast agents argue against the generalized us of these agents. This article aims to evaluate the effects of omitting the use of this type of oral contrast material for computed tomography examinations required in the emergency department for suspicion of acute abdominal pathology through an efficient literature search among recent publications.

[Clinical and analytical manifestations of primary antiphospholipid antibody syndrome]. / Manifestaciones clínicas y analíticas del síndrome de anticuerpos antifosfolípido primario.

STUDY OBJECTIVE: Description of the clinical and analytical manifestations of 8 patients with Primary Antiphospholipid Syndrome (PAPS). DESIGN: Series of cases. SETTING: Patients seen in the Internal Medicine Department of a third level Medical Center in Malaga Province. PATIENTS AND INTERVENTIONS: We describe the symptoms and signs, as well as the analytical determinations that may be related with autoimmunity in 8 patients diagnosed of PAPS (Harris' Criteria). The antiphospholipid antibodies were determined by a) Biologic false-positive Venereal Disease Research Laboratory (BFP-VDRL), b) Lupus Anticoagulant (LAC): Enlargement of the activated thromboplastin partial time > 6" and Exner test, c) Anticardiolipin antibodies (aCL), IgG (UGPL/ml), IgM (UMPL/ml) by enzyme-linked immunosorbent assay (ELISA). RESULTS: Four patients were females and four males. The mean age was 35.1 +/- 13.6. None of the patients had criteria of systemic lupus erythematous. The principal clinical manifestations of the PAPS were the venous and arterial thrombotic events in different areas (7 patients); The female patient that didn't have thrombotic event presented thrombocytopenia. Only one patient had 1 abortion. The four females had livedo reticularis (LVR), associated in two of them with arterial hypertension and stroke (Sneddon syndrome). Others manifestations seen, have been, Raynaud's phenomenon, acrocyanosis, migraine, arthritis and myositis. All the patients had IgG aCL, 3 IgM aCL, 7 enlargement of the activated thromboplastin partial time and none presented VRL. Five patient had positive antinuclear antibodies (ANA), but none of them had anti- DNA, hypocomplementemia nor lymphopenia. As far as treatment goes three of the patients are anticoagulated with continuous dicoumarins . The remaining patients keep treatment with platelet antiaggregant, had a satisfactory evolution. CONCLUSIONS: This group of patients presented venous and arterial thrombotic events such as principal manifestation of the PAPS. The most sensitive test to detect antiphospholipid antibodies were the enlargement of the activated thromboplastin partial time and the aCL. It could be interest the determination of aCL in young people the present thrombotic events without another apparent cause.