[Use of topical non-steroidal anti-inflammatory agents in an urban health center. Comparison with the current evidence]. / Uso de antiinflamatorios tópicos en un centro de salud urbano. Estudio comparativo con la evidencia actual.

OBJECTIVE: To describe the prescribing of topical non-steroidal anti-inflammatory drugs (NSAIDs) in an urban health center (Zaragoza, Spain). PATIENTS AND METHODS: A cross-sectional descriptive study was conducted on subjects who belonged to an urban center and were studied during the year 2010. The sample size with a confidence level of 95%, was calculated, a total of 843 prescriptions were analyzed. The sample was single random, and 150 cases were selected. The prevalence and confidence intervals were calculated. The statistical package STATA 9.1 was used for the calculations. RESULTS: The most used drug was diclofenac, in 27.33% (95% CI: 20.65-34.88). NSAIDs were most used in females. In 18% of the cases the area of application was the knee, followed by the 15% in the lower back area (95% CI: 10,22-21,78). There were no adverse reactions. CONCLUSIONS: Frequent use is made of topical NSAIDs in a basic health area. Current recommendations support the use in the knee and in the hand, but not in the back, where its use is common. The use of topical NSAIDs decreases side effects and drug interactions, therefore their use is recommended in patients on multiple drug therapy and in the elderly.

Uso de antiinflamatorios tópicos en un centro de salud urbano. Estudio comparativo con la evidencia actual / Use of topical non-steroidal anti-inflammatory agents in an urban health center. Comparison with the current evidence

Objetivo. Descripción de la prescripción de antiinflamatorios no esteroideos (AINE) tópicos en un centro de salud urbano (Zaragoza). Pacientes y métodos. Estudio transversal realizado en un centro de salud durante el año 2010. Se incluyó a 843 pacientes que tenían prescrito un AINE. Se calculó el tamaño muestral para un nivel de confianza del 95%, seleccionándose aleatoriamente 150 historias clínicas. Se calcularon prevalencias de uso y sus intervalos de confianza. Se utilizó el programa estadístico STATA 9.1. Resultados. El fármaco más utilizado fue el diclofenaco con el 27,33% (IC 95%: 20,65-34,88) del total de prescripciones. Su uso resultó más frecuente en el sexo femenino. En el 18% de los casos la zona de aplicación fue la rodilla (IC 95%: 12,46-24,76), seguida de la región lumbar con un 15,33% (IC 95%: 10,22-21,78). No se registraron reacciones adversas. Existen fallos en el registro, sobre todo en la dosificación y la duración de los episodios. Conclusiones. El uso de AINE tópicos en la zona básica de salud estudiada es frecuente. Las recomendaciones actuales avalan su utilización en el dolor leve o moderado de rodilla, mano y codo, pero no en la espalda, para donde se prescribe de forma frecuente. El uso de AINE tópicos presenta menos efectos secundarios e interacciones farmacológicas que la vía oral, por lo que su uso es recomendable en pacientes polimedicados y de edad avanzada (AU)

Objective. To describe the prescribing of topical non-steroidal anti-inflammatory drugs (NSAIDs) in an urban health center (Zaragoza, Spain). Patients and methods. A cross-sectional descriptive study was conducted on subjects who belonged to an urban center and were studied during the year 2010. The sample size with a confidence level of 95%, was calculated, a total of 843 prescriptions were analyzed. The sample was single random, and 150 cases were selected. The prevalence and confidence intervals were calculated. The statistical package STATA 9.1 was used for the calculations. Results. The most used drug was diclofenac, in 27.33% (95% CI: 20.65-34.88). NSAIDs were most used in females. In 18% of the cases the area of application was the knee, followed by the 15% in the lower back area (95% CI: 10,22-21,78). There were no adverse reactions. Conclusions. Frequent use is made of topical NSAIDs in a basic health area. Current recommendations support the use in the knee and in the hand, but not in the back, where its use is common. The use of topical NSAIDs decreases side effects and drug interactions, therefore their use is recommended in patients on multiple drug therapy and in the elderly (AU)

[Dyspnoea in a schizophrenic patient: an unexpected diagnosis]. / Disnea en paciente esquizofrénico. Diagnóstico inesperado.

Dyspnoea is mainly of cardio-respiratory origin. A diagnosis of psychogenic origin should not be made without having undertaken the necessary complementary tests to rule out any underlying organic cause, even if the patient has a psychiatric history. We present a clinical case with a clinical picture of dyspnoea, in a 30 year-old male of African origin with a history of schizophrenia. Oedemas can also be associated with dyspnoea. Cardiomegaly and hypertrophy of the left ventricle were established, using additional basic tests. The diagnostic confirmation of dilated cardiomyopathy was obtained from the echocardiogram. He was diagnosed in D phase, with decompensated heart failure, which was refractory to treatment, and after several incidents of malignant arrhythmias, the patient died. According to the ACC/AHA classification, the definitive treatment in this phase is the heart transplant. In the present case, urgent intervention was not considered, due to the worsening of the psychiatric pathology and active drug-taking.

Disnea en paciente esquizofrénico. Diagnóstico inesperado / Dyspnoea in a schizophrenic patient: an unexpected diagnosis

Presentamos un caso clínico cuyos síntomas guías son disnea y edemas en un varón de raza negra de 30 años de edad, con antecedentes de esquizofrenia. Se encontraron cardiomegalia e hipertrofia ventricular izquierda en pruebas complementarias básicas. La confirmación diagnóstica de miocardiopatía dilatada se realizó mediante ecocardiograma. Nuestro paciente se diagnosticó en estadio D, con descompensación de insuficiencia cardíaca resistente al tratamiento y tras varios episodios de arritmias malignas falleció. Según la clasificación de la ACC/AHA, el tratamiento definitivo en dicho estadio es el trasplante cardíaco. En este caso fue desestimada su realización urgente, por agudización de enfermedad psiquiátrica y consumo activo de tóxicos. La etiología más frecuente de disnea es de origen cardiorrespiratorio. No debemos tipificar el origen psicógeno de la misma, aunque el paciente tenga antecedentes psiquiátricos, sin haber realizado las pruebas complementarias necesarias para descartar una causa orgánica (AU)

Dyspnoea is mainly of cardio-respiratory origin. A diagnosis of psychogenic origin should not be made without having undertaken the necessary complementary tests to rule out any underlying organic cause, even if the patient has a psychiatric history. We present a clinical case with a clinical picture of dyspnoea, in a 30 year-old male of African origin with a history of schizophrenia. Oedemas can also be associated with dyspnoea. Cardiomegaly and hypertrophy of the left ventricle were established, using additional basic tests. The diagnostic confirmation of dilated cardiomyopathy was obtained from the echocardiogram. He was diagnosed in D phase, with decompensated heart failure, which was refractory to treatment, and after several incidents of malignant arrhythmias, the patient died. According to the ACC/AHA classification, the definitive treatment in this phase is the heart transplant. In the present case, urgent intervention was not considered, due to the worsening of the psychiatric pathology and active drug-taking (AU)