Pancitopenia secundaria a intoxicación por metotrexato en paciente anciano / Pancytopenia secondary to methotrexate poisoning in an elderly patient

No disponible

Encefalopatía tras neumonía por Legionella pneumophila / Encephalopathy after Legionella pneumophila pneumonia

No disponible

Encefalitis de Bickerstaff: a propósito de un caso / Bickerstaff encephalitis: a case report

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Control de la presión arterial en una población hipertensa diabética asistida en atención primaria. «Estudio PRESCAP-Diabetes» / Blood pressure control in a diabetic hypertensive population attended in primary care setting. “PRESCAP-Diabetes study”

Objetivos: Conocer el grado de control de la PA en una amplia muestra de pacientes hipertensos diabéticos atendidos en atención primaria, y determinar los factores asociados al mal control tensional. Material y métodos: Estudio transversal y multicéntrico que incluyó a hipertensos diabéticos de 18 años o más, reclutados mediante muestreo consecutivo por médicos de familia de toda España. La medida de PA se realizó siguiendo normas estandarizadas, calculándose la media aritmética de al menos 2 tomas sucesivas separadas entre sí 2 minutos. Se consideró buen control de la HTA al promedio de PA inferior a 140/90mmHg según recomienda la European Society Hypertension (ESH 2009). Se evaluó igualmente el porcentaje de pacientes con PA por debajo de 130/80mmHg (ESH 2007 y American Diabetes Association 2010). Se registraron datos sociodemográficos, clínicos, factores de riesgo cardiovascular, trastornos clínicos asociados y tratamientos farmacológicos. Resultados: Se incluyeron a 2.752 pacientes (55,6% mujeres) con una edad media de 67,1 (9,8) años. El 64,3% presentaba dislipemia, 61,8% sedentarismo, 46,5% obesidad, 41,2% antecedentes de ECV y el 16,0% tabaquismo. El 66,1% recibía terapia combinada (2 fármacos 43,5%, 3 fármacos17,9% y 4 fármacos o más 4,7%). Siguiendo las recomendaciones de 2009 el 47,3% (IC 95%: 45,4–49,2) presentó buen control de PAS y PAD, 50,2% (IC 95%: 48,3–52,1) solo de PAS y el 79,8% (IC 95%: 78,3–81,3) únicamente de PAD; considerando los criterios de 2007 el 15,1% (IC 95%: 13,8–16,4) mostró buen control de PAS y PAD, 22,5% (IC 95%: 20,9–24,1) de PAS y el 38,2% (IC 95%: 36,4–40,0) de PAD. La obesidad, el sedentarismo y no haber tomado la medicación el día de la visita fueron los factores que más se asociaron al mal control de la HTA (χ2 de Wald; p<0,01)...(AU)

Objectives: To know the grade of blood pressure (BP) control in a large sample of diabetic hypertensive patients attended in Primary Care (PC) and to determine the factors associated to poor blood pressure control. Material and methods: A cross-sectional and multicenter study that included diabetic hypertensive subjects of 18 years or older, recruited by consecutive sampling by family doctors throughout Spain. The measurement of BP was performed following standardized guidelines, calculating the arithmetic mean of at least two successive measurements separated by two minutes. Good control of arterial hypertension (AHT) was considered to be the average of BP lower than 140/90mmHg as recommended by the European Society Hypertension (ESH 2009). The percentage of patients with BP below 130/80mmHg (ESH 2007 and American Diabetes Association 2010) was also evaluated. Socio-demographic, clinical data, cardiovascular risk factors, associated clinical disorders and drug treatments were also recorded. Results: A total of 2752 patients (55.6% women) with a mean (SD) age of 67.1 (9.8) years were included. Of these, 64.3% presented dyslipidemia, 61.8% sedentary life style, 46.5% obesity, 41.2% background of cardiovascular disease and 16.0% smoked. A total of 66.1% received combined therapy (two drugs 43.5%, three 17.9% and four or more 4.7%). Following the 2009 recommendations, 47.3% (95% CI: 45.4–49.2) had good control of the systolic BP (SBP) and diastolic BP (DBP), 50.2% (95% CI: 48.3–52.1) only of the SBP and 79.8% (95% CI: 78.3–81.3) only of DBP. Considering the 2007 criteria, 15.1% (95% CI: 13.8–16.4) showed good control of SBP and DBP, 22.5% (95% CI: 20.9–24.1) of SBP and 38.2% (95% CI: 36.4–40.0) of DBP. Obesity, sedentary life, and not having taken the medication on the day of the visit were the factors that were most associated to the poor control of AHT (Wald χ2; p<0.01)...(AU)

Adolescente con astenia: a propósito de un caso / No disponible

Mujer de 15 años de edad que consulta a su médico de cabecera por astenia, prurito generalizado y caída del cabello en los meses de verano. Se realiza una analítica general que pone de manifiesto una anemia ferropénica en una paciente con antecedentes de hipermenorrea, por lo que se le prescribe hierro oral. A las 3 semanas acude al Servicio de Urgencias del hospital por un empeoramiento clínico (se añade disnea con mínimos esfuerzos y ortopnea). En la analítica se observa una leucocitosis con desviación a la izquierda y en la radiografía de tórax patrón de insuficiencia cardíaca y masa mediastínica supracardíaca. Ingresa en el Servicio de Medicina Interna y tras realizar una tomografía computarizada(TC) de tórax, pericardio centesis, una punción aspiración con aguja fina (PAAF) guiada por TC y biopsia por toracoscopia se le diagnostica un linfoma mediastínico primario tipo B de células grandes esclerosante. Con corticoides, un tratamiento hormonal y quimioterapia durante 2 años se produce una resolución completa de la enfermedad (AU)

A 15-year old woman consulted her medical practitioner due to asthenia, generalized itching and hair loss in the summer months. The general laboratory analysis showed iron deficiency anemia in the context of a patient with a background of hypermenorrhea. Oral iron was prescribed. At3 weeks, she came to the hospital emergency due to clinical deterioration (dyspnea on minimum efforts and orthopnea).The laboratory tests showed leukocytosis and left deviation and the chest X-ray showed a pattern of heart failure and supracardial mediastinal mass. She was admitted to the Internal Medicine Department and was diagnosed of primary mediastinal large-B-cell lymphoma with sclerosis after a Chest CT scan, pericardio centesis, CT-guided FNAB and biopsy by thoracoscopy. Complete resolution of her disease was obtained after 2 years with corticoids, hormonal therapy and chemotherapy (AU)

Neuropatía pudenda: a propósito de un caso / No disponible

La neuropatía pudenda o atrapamiento del nervio pudendo fue descrito por primera vez en 1987. Se presenta con un dolor neuropático perineal y/o pelviano, que se agrava al sentarse y disminuye o desaparece al estar de pie, habitualmente no suele presentarse al acostarse (pueden dormir) y que puede asociarse a disfunción urinaria, anal e incluso sexual. El nervio pudendo tiene tres ramas terminales en diferente proporción de fibras motoras, sensitivas y autonómicas. Por ello, su atrapamiento puede causar signos y síntomas tanto a nivel sensitivo, como motor o autonómico (en total se estima que el 30% es autonómico, y el 70% es somático,50% sensitivo y 20% motor). Su diagnóstico es básicamente clínico y se confirma con la compresión del nervio pudendo en la electromiografía. El tratamiento consiste en el autocuidado, infiltraciones perineurales y cirugía de descompresión del nervio (AU)

Pudendal neuropathy or pudendal nerve entrapment wasfirst described in 1987. It presents with a perineal neuropathicand/or pelvic pain, which worsens when the subject is sitting and decreases or disappears when the subject is standing, It is usually absent at bedtime (the individual can sleep) and may be associated with urinary, anal and even sexual dysfunction. The pudendal nerve has three terminal branches in different proportions of motor, sensitive and autonomic fibers. Hence, its entrapment can cause sensitive, motor or autonomic signs and symptoms (as a whole, it is estimated that 30% is autonomic, 70% somatic, the latter divided into 50% sensitive and 20% motor). Its diagnosis is essential clinical and it is confirmed with the compression of the pudendal nerve in the electromyography. Treatment consists in self-care, perineural infiltrations and decompression nerve surgery (AU)

Coxalgia prolongada en el tiempo: a propósito de dos casos / Prolonged coxalgia: two case reports

Estudio de dos pacientes con dolor intenso de cadera, sin causa aparente, que aumenta al caminar o subir escaleras y mejora con el reposo. En la radiografía de caderas se observan signos de inflamación, que se confirman con la ecografía de partes blandas en dicha zona, y que en la resonancia magnética nuclear (RMN) se informan como necrosis avascular de cabeza femoral. El tratamiento en los dos enfermos fue conservador (reposo y antiinflamatorios no esteroideos [AINE], principalmente), resolviéndose ambos casos sin secuelas clínicas, con RMN de control normal y confirmando el diagnóstico de osteoporosis transitoria de cadera

Study of two patients with intense hip pain without apparent cause that increases when they walk and climb stairs, and improves with rest. The hip X-ray shows signs of inflammation, that is confirmed with the soft tissue ultrasonography in that area and the MRI shows it as femoral head avascular necrosis. Treatment of the two patients was conservative (mainly rest and NSAIDs), both cases resolving without clinical sequels, with normal MRI control and in which the diagnosis of transient hip osteoporosis was confirmed

[Blood pressure measurement devices used in primary care office]. / Aparatos de medida de la presión arterial utilizados en las consultas de atención primaria.

OBJECTIVE: To know different blood pressure (BP) measurement devices used in primary care (PC). DESIGN: Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country. SETTING: Primary care practices from all the country. PARTICIPANTS: PC patients treated and they all were of age. METHODS: Two consecutive BP measures were made and measurement devices used in this process by physicians were booked. RESULTS: In this study participated 3592 PC physicians, BP were measured to 14,137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device. CONCLUSIONS: In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted.

Aparatos de medida de la presión arterial utilizados en las consultas de atención primaria / Blood pressure measurement devices used in primary care office

Objetivo. Conocer diferentes aparatos de medida de la presión arterial (PA) utilizados en atención primaria (AP). Diseño. Estudio transversal, multicéntrico, con muestreo no probabilístico de selección de casos consecutivos. Emplazamiento. Consultas de atención primaria de todo el Estado. Participantes. Pacientes hipertensos tratados > 18 años de edad. Métodos. Se hicieron 2 medidas consecutivas de PA y se anotaron los aparatos de medida utilizados. Resultados. Participaron en el estudio 3.592 médicos de AP que midieron la PA en 14.137 pacientes. En un 69,8% de los pacientes, la PA se midió con un esfigmomanómetro de mercurio, en un 16,5% con un aparato electrónico, en un 11,8% con un manómetro aneroide y en un 1,9% con más de un método de medida. En el medio rural se utilizaron más los aparatos electrónicos y los manómetros aneroides, observándose diferencias en las distintas comunidades autónomas de nuestro país. Había diferencias en los valores de PA según el método de medida; la tercera medida la realizaron con más frecuencia los médicos que empleaban aparatos electrónicos y la utilización de los dígitos 0 y 5 fue mayor cuando el método de medida no era un aparato electrónico. Conclusiones. En las consultas de AP se siguen utilizando preferentemente los esfigmomanómetros de mercurio y también los aparatos aneroides. Su utilización implica sesgos importantes en el proceso de medición: por ello, se debería fomentar el uso de los aparatos electrónicos para medir la PA

Objective. To know different blood pressure (BP) measurement devices used in primary care (PC). Design. Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country. Setting. Primary care practics from all the country. Participants. PC patients treated and they all were of age. Methods. Two consecutive BP measures were made and measurement devices used in this process by physicians were booked. Results. In this study participated 3592 PC physicians, BP were measured to 14 137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device. Conclusions. In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted