Vitamina D para la práctica diaria / Vitamin D for daily practice

La vitamina D es una vitamina liposoluble cuya principal función en el organismo es la regulación del metabolismo calcio-fósforo. El receptor de la vitamina D está presente en la mayoría de las células nucleadas de nuestro organismo, por lo que se está descubriendo su intervención en múltiples procesos. Las 3 principales fuentes para su obtención son la radiación ultravioleta, la alimentación y la suplementación. La piel, a través de la radiación solar, proporciona el 90% de la vitamina D que necesitamos. En casos deficitarios se han de repasar los hábitos de exposición solar, alimentación y se ha de valorar la suplementación farmacológica. La medición en el organismo se realiza mediante la determinación de 25-hidroxicolecalciferol y valores por debajo de 20ng/ml se consideran inadecuados. En el momento actual no se recomienda el cribado universal de vitamina D, sino en aquellos casos en los que se sospeche un déficit

Vitamin D is a fat-soluble vitamin which has the regulation of calcium-phosphorus metabolism in the body as its main function. Vitamin D receptor is present in most of the nucleated cells of the body, and its role in multiple body processes is being discovered. The 3 main sources of vitamin D are ultraviolet sun radiation, diet, and supplementation. The skin, through solar radiation, provides 90% of the bodýs vitamin D needs. In cases of low vitamin D, sun exposure habits and diet must be reviewed, and pharmacological supplementation must be assessed. Measurement in the body is performed by determining 25-hydroxycholecalciferol with values below 20ng/ml being considered insufficient. Universal screening of vitamin D is not currently recommended, only in situations where a deficiency is suspected

Recomendaciones para el manejo de la urticaria en Atención Primaria / Recommendations on the management of urticaria in Primary Care

La urticaria es un motivo frecuente de consulta en Atención Primaria (AP); sin embargo, el correcto abordaje de esta enfermedad resulta controvertido y con frecuencia no está bien establecido. Por esta razón, se necesita esclarecer sus causas y desarrollar protocolos de tratamiento para mejorar el manejo de la urticaria en AP. Con este objetivo se ha realizado este trabajo. Un grupo de expertos en AP y dermatología, con experiencia en el tratamiento de la urticaria, han revisado las principales guías y publicaciones en urticaria con motivo de desarrollar recomendaciones claras e interdisciplinares sobre el manejo de la urticaria en AP. En este artículo presentamos nuestras recomendaciones basadas en el consenso de expertos, incluyendo algoritmos de diagnóstico y tratamiento simples y prácticos. Estas guías pueden ayudar a optimizar el manejo del paciente con urticaria, incrementar su calidad de vida y reducir los costes socioeconómicos asociados

Urticaria is a common cause for patient consultations in Primary Care (PC). However, the optimal approach to managing urticaria in PC is controversial and not well-established. For this reason, there is a clear need to clarify the causes of urticaria and to develop treatment protocols to improve urticaria management in the PC setting. The present work has been developed with this objective. A group of experts in PC and dermatology, with specific expertise in treating urticaria, have reviewed the main clinical guidelines and publications on urticaria in order to develop clear, interdisciplinary recommendations on managing urticaria. In this article, consensus-based recommendations are presented that include simple, practical diagnostic, and treatment algorithms. These guidelines will help to optimise the management of patients with urticaria, increasing their quality of life and reducing the socioeconomic costs associated with this illness

[Vitamin D for daily practice]. / Vitamina D para la práctica diaria.

Vitamin D is a fat-soluble vitamin which has the regulation of calcium-phosphorus metabolism in the body as its main function. Vitamin D receptor is present in most of the nucleated cells of the body, and its role in multiple body processes is being discovered. The 3 main sources of vitamin D are ultraviolet sun radiation, diet, and supplementation. The skin, through solar radiation, provides 90% of the bodýs vitamin D needs. In cases of low vitamin D, sun exposure habits and diet must be reviewed, and pharmacological supplementation must be assessed. Measurement in the body is performed by determining 25-hydroxycholecalciferol with values below 20ng/ml being considered insufficient. Universal screening of vitamin D is not currently recommended, only in situations where a deficiency is suspected.

Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. / Guía para el diagnóstico, el tratamiento y la prevención del eccema de manos.

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.

[Recommendations on the management of urticaria in Primary Care]. / Recomendaciones para el manejo de la urticaria en Atención Primaria.

Urticaria is a common cause for patient consultations in Primary Care (PC). However, the optimal approach to managing urticaria in PC is controversial and not well-established. For this reason, there is a clear need to clarify the causes of urticaria and to develop treatment protocols to improve urticaria management in the PC setting. The present work has been developed with this objective. A group of experts in PC and dermatology, with specific expertise in treating urticaria, have reviewed the main clinical guidelines and publications on urticaria in order to develop clear, interdisciplinary recommendations on managing urticaria. In this article, consensus-based recommendations are presented that include simple, practical diagnostic, and treatment algorithms. These guidelines will help to optimise the management of patients with urticaria, increasing their quality of life and reducing the socioeconomic costs associated with this illness.

Guía para el diagnóstico, el tratamiento y la prevención del eccema de manos / Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema

El eccema de manos es una patología frecuente con un fuerte impacto en la calidad de vida de los pacientes y un alto coste social y laboral. Su manejo por los médicos de atención primaria y de medicina del trabajo es complejo debido a la variedad de etiologías, la evolución difícilmente predecible de la enfermedad y la respuesta al tratamiento. El diagnóstico precoz y las medidas protectoras adecuadas son esenciales para evitar la cronificación, que es mucho más difícil de tratar. Una correcta derivación a un especialista y la valoración de una baja laboral en el momento adecuado resultan cruciales para un buen manejo de estos pacientes. En esta guía sobre el eccema crónico de manos analizamos el proceso diagnóstico, las medidas preventivas y los tratamientos, con especial énfasis en el papel del médico de atención primaria y de medicina del trabajo en los estados iniciales de su manejo

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease

Dermatoscopia para principiantes (II): estructuras dermatoscópicas y métodos diagnósticos / Dermoscopy for beginners (II): dermoscopic structures and diagnostic methods

La dermatoscopia (DS) es una técnica diagnóstica in vivo, no invasiva, desarrollada para estudiar las lesiones cutáneas. Mejora el diagnóstico precoz y el diagnóstico diferencial de las lesiones potencialmente malignas, especialmente el melanoma. Utiliza un dispositivo llamado dermatoscopio para visualizar estructuras cutáneas profundas no visibles a simple vista, denominadas estructuras dermatoscópicas. Únicamente algunas de ellas tienen significado histológico, basándose en ellas la DS. Se han desarrollado numerosos métodos dermatoscópicos, más o menos complejos, para ayudar en el diagnóstico diferencial del cáncer de piel. El más extendido es el algoritmo en 2 pasos o etapas. Pero existen algunos métodos más sencillos, diseñados para ser aplicados por médicos no expertos en DS. Dos de ellos resultan de gran utilidad en atención primaria: la regla de los 3 puntos y el algoritmo BLINCK. Este trabajo se centra en la descripción de los parámetros dermatoscópicos necesarios para aplicar dichos algoritmos, así como en su interpretación (AU)

Dermoscopy (DS) is an in vivo non-invasive diagnostic technique developed to study skin lesions. It improves the diagnostic accuracy of hyperpigmented lesions and early diagnosis of potentially malignant lesions, especially melanoma. It uses a device called a dermoscope to display deeper skin structures not visible to the naked eye, called dermoscopic structures. Only some of them have histological significance, basing them on DS. Many, more or less complex, dermoscopic methods have been developed to aid in the differential diagnosis of skin cancer. The most widespread is 2-step algorithm dermoscopy. But there are some more simple methods, designed to be operated by non-medical experts in DS. Two of them are useful in primary care: the 3-point checklist of DS, and the BLINCK algorithm. This paper focuses on describing the dermoscopic parameters needed to implement these algorithms, as well as their interpretation (AU)

Dermatoscopia para principiantes (I): características generales / Dermoscopy for beginners (I): general information

La incidencia de cáncer de piel está aumentando paulatinamente en el mundo desde la década de 1960. Actualmente representa un problema sanitario y económico para los diferentes sistemas de salud. La dermatoscopia es una técnica diagnóstica in vivo, no invasiva, desarrollada para estudiar las lesiones cutáneas. Mejora la precisión diagnóstica de las lesiones hiperpigmentadas y el diagnóstico precoz de las lesiones potencialmente malignas, especialmente el melanoma. No incrementa significativamente el tiempo dedicado a la exploración física. Actualmente se están descubriendo nuevas aplicaciones para esta técnica. Requiere un proceso de aprendizaje. Debido a la complejidad del tema, hemos dividido el texto en 2 partes, para intentar simplificar su exposición. Esta primera parte se centrará en los aspectos más técnicos y en las características del dispositivo denominado dermatoscopio. En la segunda parte se expondrán 2 métodos diagnósticos de sencilla interpretación y gran utilidad en Atención Primaria (AU)

The incidence of skin cancer has been gradually increasing worldwide since the 1960s. It is currently a health and economic problem for the different health systems. Dermoscopy is a non-invasive in vivo diagnostic technique, developed to study skin lesions. It improves the diagnostic accuracy of hyperpigmented lesions, as well as an early diagnosis of potentially malignant lesions, especially melanoma. The time spent on physical examination is not significantly increased. New applications have currently been discovered for this technique. Dermoscopy requires a learning process. Due to the complexity of the topic, the text has been divided into 2 parts to try to simplify its presentation. This first part will focus on the more technical aspects and the characteristics of the device called dermoscope. In the second part, 2 diagnostical methods will be presented along with their easy interpretation and usefulness in Primary Care (AU)

[Dermoscopy for beginners (i): General information]. / Dermatoscopia para principiantes (i): características generales.

The incidence of skin cancer has been gradually increasing worldwide since the 1960s. It is currently a health and economic problem for the different health systems. Dermoscopy is a non-invasive in vivo diagnostic technique, developed to study skin lesions. It improves the diagnostic accuracy of hyperpigmented lesions, as well as an early diagnosis of potentially malignant lesions, especially melanoma. The time spent on physical examination is not significantly increased. New applications have currently been discovered for this technique. Dermoscopy requires a learning process. Due to the complexity of the topic, the text has been divided into 2 parts to try to simplify its presentation. This first part will focus on the more technical aspects and the characteristics of the device called dermoscope. In the second part, 2 diagnostical methods will be presented along with their easy interpretation and usefulness in Primary Care.

[Dermoscopy for beginners (ii): Dermoscopic structures and diagnostic methods]. / Dermatoscopia para principiantes (ii): estructuras dermatoscópicas y métodos diagnósticos.

Dermoscopy (DS) is an in vivo non-invasive diagnostic technique developed to study skin lesions. It improves the diagnostic accuracy of hyperpigmented lesions and early diagnosis of potentially malignant lesions, especially melanoma. It uses a device called a dermoscope to display deeper skin structures not visible to the naked eye, called dermoscopic structures. Only some of them have histological significance, basing them on DS. Many, more or less complex, dermoscopic methods have been developed to aid in the differential diagnosis of skin cancer. The most widespread is 2-step algorithm dermoscopy. But there are some more simple methods, designed to be operated by non-medical experts in DS. Two of them are useful in primary care: the 3-point checklist of DS, and the BLINCK algorithm. This paper focuses on describing the dermoscopic parameters needed to implement these algorithms, as well as their interpretation.

Carcinoma suprarrenal en mujer de 23 años. Presentación de un caso / Adrenal carcinoma in a 23 year-old woman: presentation of a case

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Chikungunya, una enfermedad vírica emergente. Propuesta de un algoritmo de manejo clínico / Chikungunya, an emerging viral disease. Proposal of an algorithm for its clinical management

La fiebre de Chikungunya (CHIK) es una enfermedad vírica emergente. Está causada por un virus ARN del género alfavirus y la familia Togaviridae: el virus de Chikungunya. Se transmite a los humanos por la picadura de mosquitos infectados, principalmente Aedes aegypti y Aedes albopictus. Dichos mosquitos están implicados en la transmisión de otras enfermedades (dengue, malaria, otros alfavirus, etc.). Actualmente la CHIK es endémica en algunas regiones de África y del Sudeste Asiático. Se han descrito casos en Latinoamérica, Caribe y Europa (Francia, Italia y España). En España existen reservorios de los mosquitos vectores en áreas mediterráneas (Cataluña, Alicante, Murcia y las Islas Baleares). Clínicamente, la CHIK se caracteriza por fiebre elevada de inicio súbito y artromialgias simétricas graves o incluso invalidantes. Suele mejorar en días o semanas, existiendo formas graves y crónicas. No existen tratamiento ni profilaxis específicos para la CHIK. Proponemos un algoritmo de manejo basado en las últimas guías (AU)

Chikungunya fever (CHIK) is an emerging viral disease. It is caused by the Chikungunya virus, analphavirus from the Togaviridae family. It is transmitted to humans by the bite of infected mosquitoes, mainly Aedes aegypti and Aedes albopictus. They are also involved in the transmission of dengue, malaria, etc. CHIK is now endemic in any region of Africa and Southeast-Asia. Cases of CHIK have been reported in America, the Caribbean, and Europe (France, Italy and Spain). There are reservoirs of these mosquitoes in some regions of Spain (Catalonia, Alicante, Murcia and Balearic islands). CHIK is characterized by a sudden high and debilitating fever, and severe or disabling symmetrical arthralgia. It tends to improve in days or weeks. There are severe and chronic forms of CHIK. There is no specific treatment or prophylaxis for CHIK. An algorithm is proposed for the clinical management of CHIK based in the latest guidelines (AU)

[Chikungunya, an emerging viral disease. Proposal of an algorithm for its clinical management]. / Chikungunya, una enfermedad vírica emergente. Propuesta de un algoritmo de manejo clínico.

Chikungunya fever (CHIK) is an emerging viral disease. It is caused by the Chikungunya virus, an alphavirus from the Togaviridae family. It is transmitted to humans by the bite of infected mosquitoes, mainly Aedes aegypti and Aedes albopictus. They are also involved in the transmission of dengue, malaria, etc. CHIK is now endemic in any region of Africa and Southeast-Asia. Cases of CHIK have been reported in America, the Caribbean, and Europe (France, Italy and Spain). There are reservoirs of these mosquitoes in some regions of Spain (Catalonia, Alicante, Murcia and Balearic islands). CHIK is characterized by a sudden high and debilitating fever, and severe or disabling symmetrical arthralgia. It tends to improve in days or weeks. There are severe and chronic forms of CHIK. There is no specific treatment or prophylaxis for CHIK. An algorithm is proposed for the clinical management of CHIK based in the latest guidelines.

[Klippel-Feil syndrome, a rare cervicalgia]. / Síndrome de Klippel-Feil, una cervicalgia poco frecuente.

Cervicalgia is defined as the presence of pain in the neck region, and can radiate to the shoulders, upper limbs or back. It is a source of frequent visits to Primary Care, and more than half of the general population will suffer neck pain at some point in their life. Klippel-Feil syndrome is an exceptional cause of cervicalgia. It belongs to the group of so-called malformations of the hold-down skull-cervical congenital disease. Klippel-Feil syndrome is a complex disease entity characterized by the fusion of two or more vertebrae, and may also be associated with other bone and visceral disorders. The characteristic clinical triad consists of short-neck, implantation below the hair in the occipital region, and limitation of cervical mobility. However, this clinical picture is present in less than 50% of these patients.

Esofagitis candidiásica en una paciente inmunocompetente. A propósito de un caso / Candida esophagitis in an immunocompetent woman. A case report

La esofagitis candidiásica (EC) es una de las formas invasivas de candidiasis. Su prevalencia diagnosticada mediante endoscopia digestiva alta oscila entre 0,77-2,4%. Su principal causa es la Candida albicans (CA). La EC afecta con mayor frecuencia a sujetos inmunodeprimidos, aunque también puede aparecer en sujetos sanos. Precisa tratamiento antifúngico sistémico. Presentamos el caso de una EC en una paciente sana con buena respuesta al tratamiento pautado, potencialmente relacionado con la toma de omeprazol por parte de la paciente (AU)

Candida esophagitis (CE) is one of the invasive infections caused by Candida albicans (CA). Its prevalence diagnosed by upper endoscopy ranges between 0.77-2.4%. Its main cause is CA. CE more often affects immunocompromised people, however it may affect healthy people too. CE requires systemic antifungal therapy. We report a case of a CE in a healthy woman who presented good response to prescribed treatment. Omeprazole might be involved in the development of her CE (AU)

Síndrome de Klippel-Feil, una cervicalgia poco frecuente / Klippel-Feil syndrome, a rare cervicalgia

La cervicalgia se define por la presencia de dolor en la región del cuello, pudiendo irradiarse o no a hombros, miembros superiores y/o espalda. Representa un motivo de consulta frecuente en atención primaria: más de la mitad de la población general presentará en algún momento de su vida dolor cervical. El síndrome de Klippel-Feil es una causa excepcional de cervicalgia. Es una enfermedad congénita del grupo de las denominadas malformaciones de la charnela craneocervical. Es una entidad nosológica compleja caracterizada por la fusión de 2 o más vértebras, pudiendo asociar también otras malformaciones y alteraciones óseas y viscerales. La tríada clínica característica consiste en cuello corto, implantación baja del cabello en la región occipital y limitación de la movilidad cervical. No obstante, dicha clínica está presente en menos del 50% de los pacientes (AU)

We present the case of a patient with chronic low back pain with an unfavourable progression despite the prescribed pharmacological treatment. The patient had symptoms associated with compression of the sciatic nerve in an atypical area. As it passed through the piriformis muscle, it was diagnosed as piriformis muscle syndrome. This diagnosis was based on the clinical signs and symptoms and the determination of the tests performed, with the imaging tests being absolutely normal. Treatment is basically with non-steroidal anti-inflammatory drugs, muscle relaxants and stretching exercises of this muscle (AU)

[Candida esophagitis in an immunocompetent women. A case report]. / Esofagitis candidiásica en una paciente inmunocompetente. A propósito de un caso.

Candida esophagitis (CE) is one of the invasive infections caused by Candida albicans (CA). Its prevalence diagnosed by upper endoscopy ranges between 0.77-2.4%. Its main cause is CA. CE more often affects immunocompromised people, however it may affect healthy people too. CE requires systemic antifungal therapy. We report a case of a CE in a healthy woman who presented good response to prescribed treatment. Omeprazole might be involved in the development of her CE.

Síndrome de Mirizzi, una causa infrecuente de ictericia obstructiva / Mirizzi Syndrome, a rare cause of obstructive jaundice

El dolor abdominal es un motivo de consulta muy frecuente en atención primaria. La variabilidad de entidades nosológicas que presenta complica su diagnóstico diferencial. Las principales causas de dolor en hipocondrio derecho son biliares (cólico biliar, colecistitis y colangitis). El síndrome de Mirizzi es una complicación que aparece en aproximadamente el 1% de los pacientes con colelitiasis. Consiste en la impactación de un cálculo en el infundíbulo de la vesícula o el conducto cístico que comprime el conducto hepático común, pudiendo erosionarlo y generar una fístula colecisto-coledociana. Cursa clínicamente como ictericia obstructiva, asociándose frecuentemente a cáncer de vesícula. Se diagnostica mediante ecografía abdominal, confirmándose mediante colangiopancreatografía retrógrada endoscópica, colangiografía percutánea o colangio-resonancia. Su tratamiento es quirúrgico, pudiendo realizarse por vía laparoscópica o abierta en función de su estadio (AU)

Abdominal pain is a common cause of consultation in primary care. The variability in disease conditions with this pain complicates differential diagnosis. The main causes of right upper quadrant pain are bile (biliary colic, cholecystitis and cholangitis). Mirizzi syndrome is a complication that occurs in approximately 1% of patients with cholelithiasis. It consists of the impaction of calculi in the neck of the gallbladder or cystic duct that compresses the common hepatic duct, which may erode and create a cholecystocholedochal fistula. It clinically appears as obstructive jaundice, frequently associated with gallbladder cancer. It is diagnosed by ultrasound, confirmed by endoscopic retrograde cholangiopancreatography, percutaneous cholangiography or resonance-cholangiopancreatography. Treatment is surgical and can be performed by laparoscopic or open surgery, depending on the staging (AU)