Profilaxis pre-exposición de la infección por el VIH y Atención Primaria (AP) / Pre-exposure prophylaxis for HIV infection and Primary Care (PA)

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VIH y atención primaria. Volver a pensar en el sida / HIV and primary care. Think back to AIDS

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[Pain management in elderly people in primary care (ADA Study)]. / Manejo del dolor del anciano en Atención Primaria (Estudio ADA).

OBJECTIVE: The main purpose of this study is to obtain information concerning type, clinical evaluation and therapeutic management of pain in elderly people in a Primary Care setting. METHODOLOGY: Observational prospective study, conducted in the Primary Care setting in elderly patients, who were attended in the doctor's office with pain as main or secondary symptom. A total of 213 physicians and 1120 patients have participated in the study. Demographic data and clinical characteristics, pain intensity (as measured by Visual Analogical Scale -VAS-), diagnostic methods, treatments and sanitary resources used have been collected. RESULTS: Pain was the main reason for visiting the physician in 86.2% of patients. The main characteristics of pain were: nociceptive pain (80.8%), lower limbs location (43.5%), degenerative etiology (71.8%) and chronic (67,7%). Pain intensity, as measured by VAS, was 7.1 +/- 1.3. Degree of satisfaction with previous analgesic treatments was good/very good in 30% of patients. The analgesics most frequently prescribed in this study were paracetamol (87.4%) and NSAID (51.2%). DISCUSSION: Chronic nociceptive pain of degenerative etiology, and not very satisfactory response with previous treatments are the main characteristics of the elderly patient with pain that were attended by the Primary Care physician.

Manejo del dolor del anciano en Atención Primaria (Estudio ADA) / Pain management in elderly people in primary care (ADA Study)

Objetivo. El objetivo de este estudio es conocer la tipología, la valoración clínica, el abordaje diagnóstico y el manejo terapéutico del dolor que los médicos de atención primaria realizan en población anciana. Metodología. Estudio prospectivo observacional realizado en atención primaria sobre pacientes ancianos que acuden a la consulta con dolor como motivo principal o acompañante. En el estudio participan un total de 213 médicos que aportan datos sobre 1.120 pacientes. Se recogen datos demográficos, clínicos, intensidad del dolor mediante la escala analógica visual, métodos diagnósticos, tratamientos y recursos sanitarios utilizados. Resultados. El dolor como motivo principal de consulta aparece en el 86,2% de los casos. Las características más frecuentes del dolor son: tipo nociceptivo (80,8%), de localización en miembros inferiores (43,5%), de etiología degenerativa (71,8%) y de evolución crónica (67,7%). La intensidad del dolor mediante la escala analógica visual era de 7,1 ± 1,3. El grado de satisfacción con tratamientos analgésicos previos fue bueno/muy bueno en el 30% de los pacientes. Los fármacos más utilizados en el presente estudio han sido paracetamol (87,4%) y antiinflamatorios no esteroideos (51,2%). Discusión. El dolor crónico, de tipo nociceptivo, de etiología degenerativa y con una respuesta no muy satisfactoria a los tratamientos previos, configuran el perfil del paciente anciano con dolor que acude a la consulta del médico de atención primaria (AU)

Pain management in elderly people in primary care (ADA Study) Objective. The main purpose of this study is to obtain information concerning type, clinical evaluation and therapeutic management of pain in elderly people in a Primary Care setting. Methodology. Observational prospective study, conducted in the Primary Care setting in elderly patients, who were attended in the doctor's office with pain as main or secondary symptom. A total of 213 physicians and 1120 patients have participated in the study. Demographic data and clinical characteristics, pain intensity (as measured by Visual Analogical Scale -VAS-), diagnostic methods, treatments and sanitary resources used have been collected. Results. Pain was the main reason for visiting the physician in 86.2% of patients. The main characteristics of pain were: nociceptive pain (80.8%), lower limbs location (43.5%), degenerative etiology (71.8%) and chronic (67,7%). Pain intensity, as measured by VAS, was 7.1 ± 1.3. Degree of satisfaction with previous analgesic treatments was good/very good in 30% of patients. The analgesics most frequently prescribed in this study were paracetamol (87.4%) and NSAID (51.2%). Discussion. Chronic nociceptive pain of degenerative etiology, and not very satisfactory response with previous treatments are the main characteristics of the elderly patient with pain that were attended by the Primary Care physician (AU)

Long-term survival in children under 3 years of age with low-grade astrocytoma.

OBJECTIVE: The purpose of this study is to analyze clinical aspects and disease-free survival (DFS) in children less than 3 years of age diagnosed with low-grade astrocytoma. METHODS: In a period of 24 years (1980-2004), a total of 43 (5.4%) children were registered with these characteristics. Twenty-three patients had pilocytic astrocytoma, 18 diffused, and 2 mixed. Thirty-one (72.1%) children had incomplete surgical tumor resection and 12 (27.9%) had a complete tumor resection. Twelve (27.9%) patients had cranial radiotherapy and 17 (39.5%) received chemotherapy. Overall survival was recorded in 23 (53%). DFS was 50% at 250 months of follow-up for the whole group. DFS for the supratentorial group was 60% at 250 months, whereas, for the infratentorial, it was 22% at 120 months (p = 0.008). CONCLUSION: The only favorable prognostic pattern was the supratentorial presentation. Radiotherapy and chemotherapy did not alter the outcome.

[Exploration of the anterior segment by optical coherence tomography-3]. / Exploración del segmento anterior mediante tomografía óptica de coherencia 3.

PURPOSE: To show the utility of optical coherence tomography (OCT) for studying the anterior segment and to explain its potential advantages as compared to ultrasonic biomicroscopy (UBM). MATERIALS AND METHODS: We have described the findings in 5 patients with different pathologies of the anterior segment, all of whom were studied with UBM and OCT-3 adjusted for the anterior segment. There were 2 cases of an acute attack of closed angle glaucoma, 1 case of rubeosis iridis, 1 case of penetrating ocular trauma and 1 case of a primary stromal iris cyst. RESULTS: OCT was found to be as useful as UBM in detecting angle closure in patients affected by an acute attack of glaucoma. In addition, OCT was more comfortable for the patient and faster than UBM in obtaining images, with the exploration mean time using OCT being less than five minutes while that with UBM was over ten minutes. OCT has also been demonstrated to be a safe and valuable non-contact examination in other iris pathologies such as rubeosis iridis, for checking the permeability of iridotomies and even for studying iris masses such as primary stromal iris cysts. In these entities OCT may reach a higher resolution than ultrasonic biomicroscopy. CONCLUSION: OCT-3, with an adjustable focus, can obtain images from the scleral angle, as well as from other ocular structures like the iris, thus assisting in the diagnosis of numerous pathologies.

[Toxicity of topical administration of lidocaine]. / Toxicidad por administración tópica de lidocaína.

It is frequently described in international literature the possibility of toxicity by local anesthesics. The lidocaine is one of them. The problems with its local use are more frequent and known but topic toxicity is also possible. We want to describe a case of toxicity by topical administration of lidocaine (Xylocain) which caused neurological disease with convulsions, and cardiological disease with ventricular fibrillation, in a patient who came for a thyroplasty. Patient's evolution was satisfactory.

Is autologous bone marrow transplant (ABMT) and high-dose chemotherapy an approach that can rescue some children with advanced cancer disease?

The object was to determine the role ABMT in children with advanced cancer Those included had failed to respond to conventional treatment with 4 different ablative chemotherapy regimens. Bone marrow stem cells were identified with CD34. Cellular viability was determined after the bone marrow extraction and before the infusion. Fifteen patients were included, whose ages ranged from 1 to 13 years old with a median of 7. Six had acute leukemia, 6 with primitive neuroectodermic tumors, and 3 with other tumors. The median disease-free survival for the whole group was of 2 months, range of 1 to 29 months and SD of 10.1. A total of 6 children are alive (40%) and without evidence of tumor activity from 1 to 29 months. The disease-free survival rate for these group was of 19.1 months, with an SD of 7.9 months.

Clinical consequences of the use of highly purified silicone oil. Comparative study of highly and less purified silicone oil.

PURPOSE: To compare the ocular toxicity caused by the use of highly purified silicone oil to less purified silicone oil in humans. METHODS: Fifty-six eyes received 2,000 centistokes (cs) purified silicone oil (group 1) and 42 eyes received 2,000 cs fractionated (highly purified) silicone oil (group 2) after pars plana vitrectormy. Follow-up ranged from 6 to 48 months. RESULTS: Six months after injection, the following complications were found in groups 1 and 2, respectively: ocular hypotension (< 13 mmHg), 39.3% and 31%, sustained ocular hypertension (> 23 mmHg), 19.6% and 19%; acute hypertensive peaks (> 30 mmHg), 23.2% and 11.9%; corneal alterations, 19.6% and 14.3%; emulsification, 1.8% and 2.4%; silicone oil cloudiness, 28.6% and 0%; preretinal reproliferation, 14.3% and 4.8% and total or partial retinal reattachment, 78.6% and 90.5%. CONCLUSIONS: Highly purified silicone oil was better tolerated than the less purified oil and caused fewer complications. Poorly purified silicone oils should be avoided in clinical practice.

[Efficiency of oxidant gas generator cells powered by electric or solar energy]. / Eficiencia de celdas generadoras de gases oxidantes alimentadas con energía eléctrica o solar.

Diseases caused by microbial contaminants in drinking water continue to be a serious problem in countries like Mexico. Chlorination, using chlorine gas or chlorine compounds, is one of the best ways to treat drinking water. However, difficulties in handling chlorine gas and the inefficiency of hypochlorite solution dosing systems--due to sociopolitical, economic, and cultural factors--have reduced the utility of these chlorination procedures, especially in far-flung and inaccessible rural communities. These problems led to the development of appropriate technologies for the disinfection of water by means of the on-site generation of mixed oxidant gases (chlorine and ozone). This system, called MOGGOD, operates through the electrolysis of a common salt solution. Simulated system evaluation using a hydraulic model allowed partial and total costs to be calculated. When powered by electrical energy from the community power grid, the system had an efficiency of 90%, and in 10 hours it was able to generate enough gases to disinfect about 200 m3 of water at a cost of approximately N$8 (US $1.30). When the electrolytic cell was run on energy supplied through a photoelectric cell, the investment costs were higher. A system fed by photovoltaic cells could be justified in isolated communities that lack electricity but have a gravity-fed water distribution system.

Medición de la frecuencia cardiaca y presión arterial en habitantes del Ajusco, Tlalpan, Distrito Federal, México, utilizando equipo CEDAT / Measurement of cardiac frecuency and blood lpressure in a district of Mexico City

Para mejorar los procedimientos de atención de la salud cardiovascular en México es indispensable que en los centros de salud puedan hacer mediciones precisas con aparatos adecuados y se cuente con valores estándar de la población. Se analizaron en 102 personas la frecuencia cardiaca (FC), presión arterial sistólica (PAS) y presión arterial diastólica (PAD) en situasión de reposo sentados, parados, haciendo 30 sentadillas y nuevamente en reposo, parados y sentados. Se encontró una relación directa entre la magnitud de FC y PA con la supérficie corporal y con la edad cronológica. El reflejo ortostático va disminuyendo en relación con el incremento de años de vida. El ejercicio físico incrementó la FC, PAS y PAD que vuelve a disminuir en los siguientes cuatro a ocho minutos consecutivos al ejercicio en las personas en las tres primeras décadas de vida, mientras que en las otras dos no regresa, dentro de este tiempo, a los valores previos. Este decremento de RO es más pronunciado en los hombres que en las mujeres, aunque las cifras de PA son mayores en mujeres en las dos últimas décadas estudiadas. La distribución de los datos parece seguir la curva de distribución normal y queda dentro de lo descrito para altitudes sobre el nivel del mar menores que la ciudad de México. Al implantar los sistemas de medición que se describen en este trabajo, se podrán detectar al inicio los procesos patológicos que afecten la actividad cardiaca y la presión arterial, en situasiones de alteración del ambiente

To improve theprocedures for cardiovascular health care in Mexico it is necessary to be able to perform accurate measurements of the cardiovascular parameters with appropriate equipment and to count with standard values for the Mexican population at the primary health level. Cardiac frequency (CF), systolic arterial pressure (DAP) and diastolic arterial pressure (DAP) were analyzed in 02 consenting volunteers under resting (seated) and standing conditions as well as during excercise (30 sitting), and again after excercise under resurge conditions. A direct relation was found between CF, SAP and DAP with body surface and age. The orthostatic reflex (OR) diminished with age. Excercise increased FC, PAS and PAD, which decreased four-eight minutes after completing the excercise in those subjetcs under 30 years of age, where as in those aged 30 to 50 years these parameters did not return to their previous values. The RO decrement is more pronounced in men, although arterial pressure values ar higher in women aged 30 to 50 years. Data followed normal distribution curve, agreeing with the data re ported for altitudes lower than that of Mexico City. Implementing the measurement systems described in thi paper will allow early detection of pathology that migh affect cardiac activity and arterial pressure that could b, related to environmental pollution at the first level o medical attention.

[Measurement of heart rate and blood pressure in the population of Ajusco, Tlalpan, Federal District, Mexico, using CEDAT equipment]. / Medición de la frecuencia cardiaca y presión arterial en habitantes del Ajusco, Tlalpan, Distrito Federal, México, utilizando equipo CEDAT.

To improve the procedures for cardiovascular health care in Mexico it is necessary to be able to perform accurate measurements of the cardiovascular parameters with appropriate equipment and to count with standard values for the Mexican population at the primary health level. Cardiac frequency (CF), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were analyzed in O2 consenting volunteers under resting (seated) and standing conditions as well as during exercise (30 sitting), and again after exercise under resurge conditions. A direct relation was found between CF, SAP and DAP with body surface and age. The orthostatic reflex (OR) diminished with age. Exercise increased FC, PAS and PAD, which decreased four-eight minutes after completing the exercise in those subjects under 30 years of age, where as in those aged 30 to 50 years these parameters did not return to their previous values. The RO decrement is more pronounced in men, although arterial pressure values are higher in women aged 30 to 50 years. Data followed a normal distribution curve, agreeing with the data reported for altitudes lower than that of Mexico City. Implementing the measurement systems described in this paper will allow early detection of pathology that might affect cardiac activity and arterial pressure that could be related to environmental pollution at the first level of medical attention.