Sciatica. Management for family physicians.

Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors' clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

Migraine review for general practice / Revisión de la migraña para la práctica habitual

Migraine continues second among the world's causes of disability. Diagnosis is based on the history and clinical examination and imaging is usually not necessary. Migraine can be subdivided depending on whether there is an aura or not and based on the frequency of the headaches. The number of headache days determines whether the patient has episodic migraine or chronic migraine. Treating migraines can be done to treatment the migraine itself and to prevent its appearance. In this review we approach the migraine from a practical point of view with updated information.

La migraña continúa siendo la segunda causa a nivel mundial de discapacidad. El diagnóstico se basa en la historia clínica y el examen clínico y las imágenes no suelen ser necesarias. La migraña se puede subdividir dependiendo de si hay un aura o no y según la frecuencia de la cefalea. El número de días con cefalea determina si el paciente tiene migraña episódica o migraña crónica. El tratamiento de las migrañas se puede realizar para tratar la migraña en sí y para prevenir su aparición. En esta revisión abordamos la migraña desde un punto de vista práctico con las últimas novedades.

Migraine review for general practice.

Migraine continues second among the world's causes of disability. Diagnosis is based on the history and clinical examination and imaging is usually not necessary. Migraine can be subdivided depending on whether there is an aura or not and based on the frequency of the headaches. The number of headache days determines whether the patient has episodic migraine or chronic migraine. Treating migraines can be done to treatment the migraine itself and to prevent its appearance. In this review we approach the migraine from a practical point of view with updated information.

Rapid antigen tests for the detection of SARS-CoV-2: A narrative review / Test rápidos de antígenos para la detección del SARS-CoV-2: Revisión narrativa

The rapid identificationand isolation of COVID-19 patients has become the cornerstone for the control of the recent outbreak. Real-time quantitative polymerase chain reaction is routinely used to confirm COVID-19 diagnosis and is considered the gold standard due to high sensitivity and specificity. Nevertheless, it usually takes several days and a relatively higher cost. Antigen tests based have emerged to cope with such disadvantages, by offering rapid results, an easy-to-use procedure, and low costs. The objective of the narrative review was to provide up-to-date data about CE-marked rapid antigen tests (RATs) for COVID-19. Given their large number, the study only focused on representative and widely used in Spain (Standard Q, Nadal, Panbio, CerTest, and Wondfo). RATs have become a very useful and validated tool for controlling the spread of COVID-19 allowing the rapid identification of active infection and isolation of positive patients. The present revision of the literature has demonstrated that sensitivity and specificity of all available RATs in Spain are high and accomplish European regulations and WHO recommendations.(AU)

La rápida identificación y aislamiento de los pacientes por COVID-19 se ha convertido en un reto para el control de la pandemia. La reacción en cadena de la polimerasa cuantitativa a tiempo real se utiliza de manera rutinaria para confirmar el diagnóstico de COVID-19 y se considera el estándar de referencia por su alta sensibilidad y especificidad. Sin embargo, normalmente lleva varios días y los costes son relativamente altos. Los test de antígeno son una herramienta rápida, fácil de realizar y de bajo coste. El objetivo de la revisión narrativa es proporcionar información actualizada sobre los test rápidos de antígenos (TRA) para COVID-19 con marcado europeo. Dado su gran número, el estudio solo se enfoca en aquellos representativos y ampliamente empleados en España (Standard Q, Nadal, Panbio, CerTest y Wondfo). Los TRA se han convertido en una herramienta validada muy útil para controlar la diseminación de la COVID-19, al permitir la identificación rápida de la infección activa y el aislamiento de pacientes positivos. La presente revisión de la literatura ha demostrado que la sensibilidad y especificidad de los TRA disponibles en España son altas y cumplen con la regulación europea y las recomendaciones de la OMS.(AU)

Rapid antigen tests for the detection of SARS-CoV-2: A narrative review.

The rapid identificationand isolation of COVID-19 patients has become the cornerstone for the control of the recent outbreak. Real-time quantitative polymerase chain reaction is routinely used to confirm COVID-19 diagnosis and is considered the gold standard due to high sensitivity and specificity. Nevertheless, it usually takes several days and a relatively higher cost. Antigen tests based have emerged to cope with such disadvantages, by offering rapid results, an easy-to-use procedure, and low costs. The objective of the narrative review was to provide up-to-date data about CE-marked rapid antigen tests (RATs) for COVID-19. Given their large number, the study only focused on representative and widely used in Spain (Standard Q, Nadal, Panbio, CerTest, and Wondfo). RATs have become a very useful and validated tool for controlling the spread of COVID-19 allowing the rapid identification of active infection and isolation of positive patients. The present revision of the literature has demonstrated that sensitivity and specificity of all available RATs in Spain are high and accomplish European regulations and WHO recommendations.

Vitamin D, the natural way.

BACKGROUND & AIMS: Vitamin D is a fat-soluble vitamin whose main function in the body is the regulation of bone mineral metabolism. In the last two decades, there has been an intensive research for possible vitamin D benefits in non-skeletal health but as today it still remains unclear. The aim of this article is to review vitamin D metabolism and the natural sources to encourage lifestyle changes to avoid deficiency. REVIEW: Universal screening for vitamin D deficiency is not warranted and it should only be done in cases with risk factors for vitamin deficiency. Vitamin D is measured in the body by determining 25-hydroxycholecalciferol; values below 20 ng/mL (50 nmol/L) are considered inadequate. The three sources of vitamin D are the ultraviolet sun radiation, diet and supplementation. The role of vitamin D supplementation out of the osteoporosis treatment and prevention still remain controversial. Healthy sun exposure and diet should be discussed with all patients with vitamin D deficiency and in general population in promoting health. The skin, through solar radiation, is the main source of vitamin D and provides 90% of the body's needs. CONCLUSIONS: Changing lifestyle habits, encouraging a controlled sun exposure and proper vitamin D diet is a preventive strategy that should be applied in our daily practice to prevent osteoporosis and other diseases associated with low vitamin D.

COVID-19 y la esperanza de la inmunidad / COVID-19 and the hope for immunity

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COPD from an everyday primary care point of view.

INTRODUCTION: The purpose of this study is to use real world evidence on treatment use to evaluate drug superiority within the same treatment group. METHODS: Retrospective cohort analysis using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP). Data includes longitudinal routine clinical data extracted from practice records of 7,890,485 patients. All subjects with an incident diagnosis of COPD in the database BIFAP between January 1 2010 and December 31 2012 were included in the cohort study. Cox regression analysis was performed to compare the hazard of COPD exacerbation outcome of the four principal cohorts (no therapy, monotherapy, double therapies with and without corticoids, and triple therapy) and within each principal cohort between the different treatment combinations. RESULTS: 27,739 patients with COPD were included in the analysis. The median age was 64 years, male proportion was 69% and 70% were smokers. 58,042.9 person--years of follow-up were obtained for the cohort with a mean follow-up of 2.09 years per subject. The strongest factor associated with an increased risk of exacerbation was suffering an exacerbation the previous year (HR = 1.82[1.76--1.87 95%CI]). No differences were found between the most frequent monotherapies, double therapies without corticoid, or triple therapy. When comparing the different combinations of double therapies with corticoid, salmeterol/fluticasone combination (HR = 1.16[1.08--1.24]) revealed a higher adjusted hazard of exacerbation when compared with formoterol/budesonide. CONCLUSIONS: Treatment with a combination of budesonide/formoterol was associated with lower exacerbations than the treatment with fluticasone/salmeterol. The analysis did not reveal any differences in terms of exacerbation in monotherapy, double therapy without corticoids, and triple therapy combinations.

Síndrome PFAPA: Causa de fiebre recurrente también en adultos / PFAPA síndrome: a cayse of recurrent fever also in adults

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El nuevo mundo de las enfermedades raras / Rare diseases’s new world

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Neuromielitis óptica de Devic / Devic neuromyelitis optica

La neuromieltis óptica (NMO) o enfermedad de Devic es un trastorno autoinmune, inflamatorio y desmielinizante del sistema nervioso central, que afecta principalmente al nervio óptico y la médula espinal. Considerada anteriormente como una variante de esclerosis múltiple (EM), hallazgos recientes han ayudado a concluir que la NMO es una entidad que presenta importantes diferencias inmunopatológicas, clínicas, de pronóstico y de respuesta al tratamiento, en comparación con la EM. El reciente descubrimiento y medición del anticuerpo antiacuaporina 4 (anti-AQP4 o también, NMO-IgG) ha reavivado el interés científico y activado la investigación de nuevas líneas de tratamiento de la NMO. Presentamos el caso clínico de un paciente varón de 10 años que acude a la consulta por presentar, tras una caída accidental, gonalgia bilateral, dorsalgia y lumbalgia que impresionan inicialmente de contusiones y que, sin embargo, tras 48 horas evolucionan negativamente con persistencia de dolor, pérdida de fuerza y parestesias en los miembros inferiores, dificultad para incorporarse, incapacidad para deambular e incontinencia urinaria. Ante la sospecha de mielitis transversa se deriva al paciente al servicio de urgencias hospitalario, donde desarrolla a las 24 horas de ingreso una neuritis óptica derecha; finalmente es diagnosticado de neuromielitis óptica o enfermedad de Devic (AU)

Neuromyelitis optica (NMO) or Devic's disease is an autoimmune, inflammatory and demyelinating disorder of the central nervous system that affects mainly the optic nerve and the spinal cord. NMO was first considered a form of multiple sclerosis (MS). However, recent findings have led to the conclusion that NMO is a distinct disorder, presenting important immunopathological, clinical, prognostic and therapeutic differences from MS. The recent discovery and measurement of the anti-aquaporine-4 antibody (anti-AQP4 or NMO-IgG) has revived the scientific interest and has boosted research of new lines of treatment for NMO. We present the clinical case of a ten year-old boy who, after an accidental fall, presents bilateral knee pain, and pain in the upper and lower back, which at first is thought to be a contusion. However, after 48 hours it develops negatively, persisting the pain, loss of strength and lower limb paraesthesia, difficulty in sitting up, inability to walk, and urinary incontinence. Transverse myelitis is suspected and the patient is sent to the hospital emergency service, where after 24 hours he develops a right optic neuritis. Finally, a neuromyelitis optica or Devic's disease is diagnosed (AU)

Linfoma en artritis reumatoide tratada con metotrexato / Lymphoma in rheumatoid arthritis treated with Methotrexate

Presentamos el caso de una mujer de 62 años con artritis reumatoide en tratamiento con metotrexato que desarrolló un linfoma de células B. Tras el análisis del caso y la revisión de la literatura descubrimos una mayor incidencia de linfomas en pacientes en tratamientos crónicos con metotrexato. Queremos llamar la atención sobre la vigilancia de pacientes con enfermedades reumatológicas en tratamiento crónico con metotrexato desde Atención Primaria debido a la mayor incidencia de linfomas. En el caso de su sospecha la suspensión del fármaco es una de las primeras medidas a realizar (AU)

We present the case of a 62 year-old woman diagnosed with Rheumatoid Arthritis and treated with methotrexate who developed a B-cell lymphoma. After case analysis and literature review we discovered an increased incidence of lymphomas in patients treated chronically with methotrexate. We would like to highlight the importance of controlling from Primary Care the patients with rheumatologic diseases treated chronically with methotrexate due to the increase in lymphoma occurrence. If a lymphoma is suspected, treatment must be stopped immediately (AU)

Apendicitis aguda tras colonoscopia / Acute appendicitis after colonoscopy

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