[Prevalence of dermatological diseases in Primary Care]. / Prevalencia de enfermedades dermatológicas en atención primaria.

OBJECTIVE: To guide the training of Primary Care physicians in the most prevalent and relevant skin pathologies, it is necessary to study their prevalence in the Primary Care consultation and describe their characteristics. MATERIALS AND METHODS: Observational cross-sectional study. It took place at the Porriño Health Center (Pontevedra, Spain). A total of 305 patients of the same quota participated, recruited in consultation during 41days between September 2018 and February 2019, selected by systematic sampling coinciding with those mentioned at the hour between 9 and 13hours and, failing that, we selected the next of those mentioned. The variables were analyzed: age, sex, educational and economic level, diagnostic means, previous diagnosis of dermatological disease, treatment, follow-up and relationship with systemic diseases. The statistical analysis performed was descriptive and bivariate by sex with chi-square and Fisher's exact tests. RESULTS: 161 women and 144 men participated, age and number of consultations being non-parametric. Median age was 59years (IQR: 42-69), with no significant differences between sexes. 69.83% (95%CI: 64.46-74.71) present between 1 and 5 types of skin lesions grouped in 33 different diagnoses. The 15 most frequent pathologies account for 77.35% (95%CI: 75.80-84.48) of diagnoses. As the most relevant pathologies, we observed two basal cell carcinomas and one squamous cell carcinoma (0.98%; 95%CI: 0.34-2.85). CONCLUSIONS: Dermatological diseases have a high prevalence in Primary Care.

Incidencia de enfermedad pulmonar obstructiva crónica en pacientes con el virus de la inmunodeficiencia humana. Análisis post-hoc del estudio viva / Incidence of chronic obstructive pulmonary disease in patients with human immunodeficiency virus. Post-hoc analysis of the viva study

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz

Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment

Causas de fallecimiento tras una media de 14 años de seguimiento en 1110 pacientes con asma (cohorte estudio perinasma) / Causes of death after an average follow-up of 14 years in 1110 patients with asthma (perinasma cohort study)

OBJETIVO: estudiar las causas de muerte en pacientes diagnosticados con asma en consultas especializadas tras una media de 14 años de seguimiento. METODOLOGÍA: se realizó un seguimiento (1998 - 2016) de 1.110 pacientes diagnosticados por primera vez de asma en consultas monográficas de asma bronquial. Se contactó telefónicamente con los pacientes. En caso de fallecimiento, buscamos la causa de muerte, según los informes de éxitus. Evaluamos estas causas en el plazo temporal referido. Los datos se expresan en % y se realizó análisis estadístico, estudiando las diferencias cualitativas con prueba de chi cuadrado, así como de las medias (DE), mediante t-student. RESULTADOS: del total estudiado, 690 pacientes (62,2%) eran mujeres (edad media 37,8 (17,6)) años y 420 (37,8%) hombres (edad media 29,5 (13,9) años, (p <0,01). Un 64,6% eran atópicos, 348 (31,4%) diagnosticados sólo de asma y 762 (68,6%) de asma con rinitis. En el periodo evaluado habían fallecido un total de 54 personas (4,9%), 46 mujeres (7,14%) y 8 hombres (1,9%). Las causas de fallecimiento fueron: 22 casos por neoplasias (40,7%), 9 casos de enfermedades del sistema circulatorio (16,6%), 2 casos por enfermedad neurodegenerativa (3,7%), 1 caso por infección (1,8%), 1 caso por asma e insuficiencia respiratoria (1,8%), 1 otras causas (1,8%) y 17 no conocido (31,4%). CONCLUSIONES: la causa más frecuente de fallecimiento de nuestros pacientes asmáticos fueron las neoplasias. El número de fallecimientos por enfermedades del sistema circulatorio fue bajo, inferior a la población general. Sólo hubo un caso recogido de fallecimiento por crisis de asma

OBJECTIVE: to study the cause of death in patients diagnosed with asthma in specialized outpatient clinics after an average follow-up of 14 years. METHODS: 1110 patients diagnosed with asthma for the first time in clinics specializing in bronchial asthma were monitored from 1998 to 2016. Patients were contacted by phone. In case of death, cause of death was determined according to the death certificate. These causes were evaluated during the abovementioned time period. The data is expressed as % and a statistical analysis was performed, studying the qualitative differences using the chi-square test as well as standard deviation using the student's t-test. RESULTS: of all patients studied, 690 (62.2%) were women (average age: 37.8 [17.6]) and 420 (37.8%) were men (average age: 29.5 [13.9]) (p <0.01). 64.6% were atopic, 348 (31.4%) were diagnosed only with asthma and 762 (68.6%) with asthma and rhinitis. During the evaluation period, a total of 54 patients died (4.9%): 46 women (7.14%) and 8 men (1.9%). The causes of death were: 22 cases due to neoplasm (40.7%), 9 cases due to circulatory system disease (16.6%), 2 cases due to neurodegenerative disease (3.7%), 1 case due to infection (1.8%), 1 case due to asthma and respiratory distress (1.8%), 1 case due to other causes (1.8%) and the cause of death was unknown in 17 patients (31.4%). CONCLUSIONS: the most frequent cause of death in our asthmatic patients was neoplasm. The number of deaths due to circulatory system disease was low, below the general population. Only one case of death due to asthma attack was recorded

Deshabituación tabáquica a largo plazo. Estudio de 1.639 pacientes incluidos en programa de intervención psicofarmacológico tras 12 años de seguimiento / Long-term tobacco cessation. A study of 1639 patients included in a sychopharmacological intervention program after 12 years of follow-up

Objetivos: evaluar la situación de abstinencia tras una media de 12 años en pacientes que realizaron un programa de intervención psicofarmacológica. Metodología: se incluyeron pacientes tratados en una Unidad Especializada de Tratamiento del Tabaquismo con terapia psicológica asociada, o no, a tratamiento farmacológico. El seguimiento inicial fue de 1 año. Se dividió en dos grupos: aquéllos pacientes en los que se objetivó abstinencia (cooximetría (CO) <5 ppm) tras el año de seguimiento (grupo A) y aquéllos pacientes no abstinentes (grupo B). Los pacientes fueron llamados por teléfono tras un periodo de 12 años de media y se comprobó la abstinencia. En caso de indicar que no fumaban, se invitó a que acudieran a nuestras consultas para confirmarlo con CO. Se consideró abstinencia confirmada (AC) si presentaban CO <5 ppm. En caso de no acudir, se indicó situación de abstinencia no confirmada (ANC). Se consideró fracaso (F) si el paciente indicaba que fumaba. Resultados: se estudiaron 1.639 pacientes (366 del grupo A y 1.273 del grupo B). A largo plazo, en el grupo A presentaron AC el 50,5% de los pacientes, ANC 11,7%, F el 20,8%, no fueron localizados el 13,9% y fallecieron el 3,6%. En el grupo B presentaron AC 5,8%, ANC 12,6%, F 45%, no localizados 29,7%, fallecidos 6,7% (p <0,01 entre ambos grupos, excepto ANC). Conclusiones: los pacientes que dejan el tabaco tras un año de seguimiento mantienen la abstinencia a largo plazo en más de la mitad de los casos

Objectives: to evaluate abstinence status after an average of 12 years in patients who underwent a psychopharmacological intervention program. Methods: the study included patients treated at a specialized tobacco cessation unit who received pharmacological treatment with or without associated psychological therapy. The initial follow-up lasted 1 year. Patients were divided into two groups: those who showed abstinence (CO-oximetry <5 ppm) after a year of followup (group A) and non-abstinent patients (group B). Patients were contacted by phone after an average of 12 years to confirm abstinence. If they indicated they did not smoke, they were invited to our clinics to confirm this with COoximetry. A CO-oximetry result of <5 ppm was considered confirmed abstinence. If patients did not visit the clinic, their status was recorded as unconfirmed abstinence. Status was considered failure if the patient indicated they smoked. Results: 1639 patients were studied (366 in group A and 1273 in group B). In the long run, abstinence was confirmed in 50.5% of patients, unconfirmed in 11.7%, 20.8% were recorded as failure, 13.9% could not be contacted and 3.6% had died in group A. In group B, 5.8% were recorded as confirmed abstinence, 12.6% as unconfirmed abstinence, 45% as failure, 29.7% could not be contacted and 6.7% had died (p <0.01 between both groups, except unconfirmed abstinence). Conclusions: patients who cease tobacco use after a year of follow-up maintain long-term abstinence in more than half of cases

Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study.

BACKGROUND: Empiric triple therapy for Helicobacter pylori should be abandoned when clarithromycin resistance rate is >15-20%. Optimisation of triple therapy (high-dose acid suppression and 14-day duration) can increase eradication rates by 10%. AIM: To compare the efficacy and safety of optimised triple (OPT-TRI) and nonbismuth quadruple concomitant (OPT-CON) therapies. METHODS: Prospective multicentre study in 16 Spanish centres using triple therapy in clinical practice. In a 3-month two-phase fashion, the first 402 patients received an OPT-TRI therapy [esomeprazole (40 mg b.d.), amoxicillin (1 g b.d) and clarithromycin (500 mg b.d) for 14 days] and the last 375 patients an OPT-CON treatment [OPT-TRI therapy plus metronidazole (500 mg b.d)]. RESULTS: Seven-hundred seventy-seven consecutive patients were included (402 OPT-TRI, 375 OPT-CON). The OPT-CON therapy achieved significantly higher eradication rates in the per-protocol [82.3% (95% CI = 78-86%) vs. 93.8% (91-96%), P < 0.001] and intention-to-treat analysis [81.3% (78-86%) vs. 90.4% (87-93%), P < 0.001]. Adverse events (97% mild/moderate) were significantly more common with OPT-CON therapy (39% vs. 47%, P = 0.016), but full compliance with therapy was similar between groups (94% vs. 92%, P = 0.4). OPT-CON therapy was the only significant predictor of successful eradication (odds ratio, 2.24; 95% CI: 1.48-3.51, P < 0.001). The rate of participating centres achieving cure rates ≥ 90% favoured OPT-CON therapy (OPT-TRI 25% vs. OPT-CON 62%). CONCLUSIONS: Empiric OPT-CON therapy achieved significantly higher cure rates (>90%) compared to OPT-TRI therapy. Addition of metronidazole to OPT-TRI therapy increased eradication rates by 10%, resulting in more mild adverse effects, but without impairing compliance with therapy.

Macroscopic small bowel mucosal injury caused by chronic nonsteroidal anti-inflammatory drugs (NSAID) use as assessed by capsule endoscopy.

OBJECTIVE: To evaluate the type, frequency, and severity of macroscopic small bowel mucosal injury after chronic NSAID intake as assessed by capsule endoscopy (CE), as well as to correlate the severity of gastroduodenal and intestinal damage in these patients. MATERIAL AND METHODS: A prospective, endoscopist-blind, controlled trial. Sixteen patients (14F/2M; age: 57.06 +/- 10.16 yrs) with osteoarthritis (OA) on chronic therapy with NSAIDs underwent CE and upper gastrointestinal endoscopy (UGE). Seventeen patients with OA (9F/2M; age: 57.47 +/- 9.82 yrs) who did not take NSAIDs were included as a control group. A scale ranging from 0 to 2 (0 = no lesions, 1-minor = red spots or petechiae, denuded areas and/or 1-5 mucosal breaks; 2-major = > 5 mucosal breaks and/or strictures, or hemorrhage) was designed to assess the severity of small bowel mucosal injuries. RESULTS: CE found intestinal lesions in 75% (12/16) of patients in the study group and in 11.76% (2/17) of controls (p < 0.01). Seven out of 16 NSAID consumers (43.75%) and none in the control group (0%) had a major small bowel mucosal injury (p < 0.01). The percentages of patients with grade 1 and 2 gastroduodenopathy in the study group, as assessed by UGE, were 37.14 and 23.81%, respectively. There was no significant difference in the rate of major enteropathy between patients with none or minor gastroduodenal injury, and those with major gastroduodenopathy (43.75 vs. 40%; p = N.S.). CONCLUSIONS: Chronic NSAID intake is associated with a high rate of small bowel mucosal injuries. Our data have failed to demonstrate a relationship between the severity of gastroduodenal and intestinal injury.

Diagnostic yield of 335 push video-enteroscopies.

BACKGROUND AND OBJECTIVES: The diagnostic yield of push enteroscopy (PE) varies widely from 13 to 78% of cases, according to the various series. The aim of this retrospective cohort study was to determine the endoscopic and histological yield of PE in our health area. PATIENTS AND METHODS: A total of 355 consecutive patients (190 males/165 females; mean age 45 years, range 15-89) underwent PE over a 6-year period, from 1997 to 2003. PE was performed under sedation and without overtube. Small-bowel mucosa biopsies were taken in 199 explorations (56%). Clinical indications for PE included: chronic diarrhea (35%), occult digestive bleeding (ODB) or iron-deficiency anemia (28%), suspected small-bowel malignancy (16%), chronic abdominal pain (28/355; 8%), follow-up of polyposis or malabsorption syndromes (7%), and abnormal radiographic findings (6%). RESULTS: PE detected lesions in 122 cases (34%); in 6 cases (6%) lesions were within the reach of esophagogastroduodenoscopy. A normal macroscopic appearance of the small intestinal mucosa with an abnormal histological study was seen in 16 patients (6%). Major findings included: malabsorptive diseases (14%), nonspecific enteropathy (5%), angiodysplasia (3,5%), lymphangiectasia (3%); jejunal polyps (2%), Crohn s disease (2%), intestinal tumors (2%), extrinsic jejunal strictures (0.5%), and other (10/355; 3%). Abnormal radiographic findings (62%), chronic diarrhea (37%) and ODB (31%) were the indications with a higher diagnostic yield. No major complications were seen. CONCLUSIONS: According to our experience, PE is a safe and useful tool for the evaluation of small-bowel disease, especially in some indications (abnormal radiographic findings, chronic diarrhea, and ODB). Small-bowel biopsy increases PE's diagnostic yield in patients with chronic diarrhea.

Opiniones, prácticas, barreras y predisposición al cambio, a la hora de dar consejo para dejar de fumar / Views, practices, barriers, and the will to change, when counselling to give up smoking is being given

Objetivo. Conocer las opiniones, las prácticas actuales, las barreras percibidas y la predisposición al cambio con respecto al consejo para dejar de fumar (CF) ofertado a los pacientes por los diferentes profesionales sanitarios (PS) de atención primaria. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centros de salud del Área Sanitaria 9, de Madrid. Participantes. Participaron 480 PS, entre médicos de familia, pediatras, residentes de medicina familiar y comunitaria, y enfermería. Mediciones. Mediante cuestionario autocumplimentado y anónimo se recogen variables sociodemográficas, sobre actitudes, creencias y utilización de estrategias en CF y sobre barreras percibidas para darlo, así como la predisposición al cambio. Resultados. Contestó al cuestionario el 75,2% (el 94,2, 61,1, 51,6 y 88% de los médicos, enfermeros, pediatras y residentes, respectivamente). El 72% pregunta de manera habitual, con un incremento hasta el 92,4% en las enfermedades relacionadas con el tabaquismo, sin diferencias respecto al sexo, el PS, el hábito tabáquico y la formación previa. El 85,8% ofrece realizar un seguimiento y el 63,5% proporciona consejos escritos. El 75% de los no fumadores se considera modelo social, frente al 40% de los fumadores. Las principales barreras son la falta de tiempo y la baja motivación en los pacientes. El 93,5% cree que es necesaria una formación específica para proporcionar CF. Conclusiones. Se pregunta y se ofrece CF, independientemente del hábito tabáquico del PS. A pesar de las barreras, hay una adecuada utilización de las estrategias para proporcionar CF. Hay buena predisposición al cambio para optimizar el CF

Objective. To get to know the opinions, current practices, perceived barriers and stage of change in respect to the smoking cessation advice (SCA) offered to patients by the different health professionals (HP) from primary care. Design. Descriptive cross-sectional study. Location. Área Sanitaria 9's Health Centers, in Madrid, Spain. Participants. 480 HPs, including primary care doctors, pediatricians, primary care residents, and nursery staff. Measurements. Using a self-filled and anonymous questionnaire, we will gather sociodemographic variables and from the HP's office, regarding the attitudes towards tobacco, efficiency beliefs and use of strategies in the advice, and the perceived barriers to give it, as well as the state of change. Results. 75.2% of the HPs filled the questionnaire (94.2%, 61.1%, 51.6%, and 88% by doctors, nurses, pediatricians, and residents respectively). 72% ask regularly, this rate increasing to 92.4% over tobacco-related diseases. No differences were made between sexes, professional types, tobacco habits, or previous attendance to courses. 85.8% offers tracing and 63.5% give written advices. Nearly 75% of non-smokers are considered social role models, that against only 40% of smokers. The main barriers found were lack of time and low motivation from the patients. 93.5% consider an specific education necessary to give efficient SCA. Conclusions. Inquiries are made and SCA is given, independently of the smoking habits of the SCA. Likewise, there is a good state of change by the HPs to optimize the treatment of tobacco dependency

Incidence and factors influencing on Helicobacter pylori infection recurrence.

OBJECTIVES: a) To determine the rate of H. pylori reinfection after successful eradication in a 4-year follow-up study; and b) To evaluate the contribution of different factors in the infection relapse. PATIENTS AND METHODS: A total of 208 patients (age range 18-81 years; average 50 years; 87 women) who had been successfully treated for H. pylori infection were included. Annually, urea breath test was assessed to determine H. pylori status after eradication. Age, sex, rural/urban environment, smoking habit, treatment regimens against H. pylori and urea breath test values were evaluated. RESULTS: reinfection occurred in 9,6% of patients observed, 6,7% (14/208) in the first year, 1,9% (4/208) in the second year, 1% (2/208) in the third and 0% in the forth. Risk factors for infection recurrence were younger age and higher values of urea breath test in the multivariante analysis. CONCLUSIONS: annual reinfection rate was 2,4 pacients-year. Younger patients and higher values of urea breath test were factors associated with a higher rate of reinfection relapse. Annually, urea breath test should be performed to detect reinfection in order to avoid ulcer complications.

Usefulness of capsule endoscopy in patients with suspected small bowel disease.

AIM: To study the usefulness and safety of capsule endoscopy as a diagnostic tool in various small bowel disorders. DESIGN: A retrospective analysis of a series of cases. MATERIAL AND METHODS: Between August 2001 and August 2002, 92 capsule endoscopy procedures were performed in 88 patients (53M/39F, age: 43.87 +/- 16.78). Indications included: chronic diarrhea (n=33); unknown abdominal pain (n=29); occult gastrointestinal bleeding or iron-deficiency anemia (n=13); abdominal discomfort in NSAID takers (n=7); staging of gastrointestinal tumors (n=4), and asymptomatic controls (n=2). Previously performed gastroscopy, colonoscopy, and small-bowel follow-through were not conclusive in all patients. RESULTS: Most frequently relevant findings included: jejuno-ileal aphtas and ulcerations (29 patients), vascular malformations (13 patients), and intestinal neoplasm (6 patients). The groups with a higher rate of findings related to this indication were occult gastrointestinal bleeding (76.92%) and chronic diarrhea (67.85%), with the lowest rate in the abdominal pain group (34.48%). Therapeutic strategy was directly changed in 36 of 88 patients (40.90%) because of capsule-endoscopic findings. The only observed complication was the failed excretion of one of the capsules because of an unknown ulcerated intestinal stricture. CONCLUSIONS: Capsule endoscopy is a safe procedure which can study the entire small bowel, meaning a valuable tool for the management of patients with suggestive signs and symptoms of intestinal disorders.

Measuring colonic transit time in chronic idiophatic constipation.

INTRODUCTION AND OBJECTIVES: Colonic transit time can define three types of delay: right colon (colonic inertial), left colon and recto sigmoid. The aim of this study is to compare clinic characteristics and manometric results among the different groups with segmental colonic transit disorder. PATIENTS AND METHODS: 61 subjects were included in our study (5 men and 56 women) with and average age of 47.5 years (range: 17-84 years). We carried our a study of segmental and total colonic transit time, with the use of radio-opaque markers and sequential abdominal X-rays. We considered that transit time was prolonged when it was longer than 72 hours, and segmental transit time, when right colon was longer than 22 hours, left colon 37.2 hours and recto-sigmoid 37.2 hours. We included different clinic data: age, sex, place of residence stool frequency, abdominal pain, painful evacuation, incomplete evacuation, evacuation desire, dietary fibre intake, use of laxatives. We practised anorectal manometry in 20 patients. RESULTS: The average total colonic transit time was 38.2 hours in normal transit and 103 hours with disorder. The frequency in the three colonic segments, when there was a long total colonic transit time, was: 40% in the left colon, 33% in the recto-sigmoid and 27% in the right colon. We analysed the clinical characteristics of these three groups, finding more frequency of painful evacuation and defecation desire and lower dietary fibre intake in recto sigmoid. The most important abnormality in anorectal manometry was the hiposensitivity in the anorectal area, that only appeared in subjects with long segmental transit time in the right colon (colonic inertia), statistically significant. CONCLUSIONS: The measurement of colonic transit time with radio-opaque markers is a simple technique that allows for the objective detection of the different groups of patients with chronic idiopathic constipation. The exact typification of the abnormality is important for the individualization of each treatment.

Ranitidine bismuth citrate in the treatment of Helicobacter pylori infection.

OBJECTIVE: Examine the effectiveness of treatments that include ranitidine bismuth citrate (RBC) for Helicobacter pylori infection. DESIGN: Prospective and randomised study. PATIENTS AND METHOD: 137 patients were included (62 women, 75 males, average age 46.9 +/- 13) diagnosed with peptic ulcer and infection by Helicobacter pylori. None had received treatment previously. 67 patients were treated with RBC 400 mg bd and clarithromycin 500 mg bd for 14 days, and 70 patients with RBC 400 mg bd, clarithromycin 500 mg bd and amoxycillin 1 g bd for 7 days. The infection eradication was proven eight weeks after treatment end. The efficacy of treatment was evaluated using the intention-to-treat method. The Chisquare test (chi 2) was used for the statistical analysis of data. RESULTS: Infection in 48 out of 67 patients (71.64%) treated with RBC-clarithromycin for 14 days was eradicated, versus 88.57% (62 out of 70) among those treated with RBC-clarithromycin-amoxycillin for 7 days, with a significant difference between both regimens (p < 0.05). CONCLUSIONS: 7-day treatment with RBC-clarithromycin-amoxycillin has a good eradication rate (88.57%) and represents a valid alternative to regimens including a PPI and two antibiotics, as both regimens have a similar efficacy. Results obtained with the double therapy of RBC-clarithromycin for 14 days were not satisfactory, the rate of eradication being 71.64%. The use of an RBC treatment for Helicobacter pylori infection should always be accompanied by two antibiotics in a triple therapy.

Anafilaxia y quiste hidatídico / Anaphylaxia and hydatid cyst

La hidatidosis es una enfermedad endémica en el área mediterránea, pero su presentación como shock anafiláctico sólo acontece en un escaso porcentaje, oscilando entre un 1 y un 7,5 per cent. Esta manifestación se produce al romperse el quiste hidatídico, liberando al exterior su contenido. El diagnóstico etiológico es fácil cuando el shock se presenta durante la manipulación quirúrgica del quiste hidatídico, pero la dificultad surge cuando se produce por la rotura espontánea del mismo. Se debe sospechar en pacientes sanos que vivan en zonas endémicas y que presenten súbitamente un cuadro de colapso vascular. No suele haber antecedentes de quistes hidatídicos en estos pacientes, aunque la historia clínica suele poner de manifiesto la existencia de antecedentes compatibles con procesos alérgicos no filiados (AU)

Ranitidina citrato de bismuto en el tratamiento de la infección por Helicobacter pylori / Ranitidine bismuth citrate in the treat ment of Helicobacter pylori infection

Objetivo: conocer la eficacia en nuestro medio de las pautas erradicadoras que incluyen ranitidina citrato de bismuto (RCB) en el tratamiento erradicador de la infección por Helicobacter pylori. Diseño: estudio aleatorio y prospectivo en 137 pacientes. Pacientes y método: se incluyen 137 pacientes (62 mujeres, 75 varones, edad media 46,9ñ13) diagnosticados de infección por Helicobacter pylori. Ninguno de los pacientes había recibido tratamiento frente a Helicobacter pylori previamente. De forma aleatoria se trataron a 67 pacientes con RCB 400 mg/12h y claritromicina 500 mg/12h durante 14 días y a 70 pacientes con RCB 400mg/12h, claritromicina 500 mg/12h y amoxicilina 1g/12h durante 7 días. La erradicación de la infección fue comprobada a las 8 semanas de finalizar el tratamiento. La eficacia del tratamiento fue evaluada por intención de tratar. Para el análisis estadístico de los datos se empleó el test de Chi-cuadrado ( 2).Resultados: de los 67 pacientes tratados con RCB-claritromicina durante 14 días erradicaron 48, lo que supone una eficacia del 71,74 por ciento, frente al 88,85 por ciento (62/70) de los tratados con RCBclaritromicina-amoxicilina durante 7 días, siendo significativa la diferencia entre ambas pautas (p<0,05).C o n c l u s i o n e s : RCB-claritromicina-amoxicilina durante 7 días constituye una alternativa válida al tratamiento erradicador de H. Pylo ri con IBP más dos antibióticos, ya que ambos regímenes tienen una eficacia erradicadora similar. No hemos obtenido buenos resultados con la doble terapia con RBC - claritromicina 14 días, siendo la tasa de erradicación del 71,74 por ciento. Cuando se utilice RBC en el tratamiento erradicador, debe ser siempre en triple terapia con dos antibióticos. (AU)

Salmonella dublin infection: a rare cause of spontaneous bacterial peritonitis and chronic colitis in alcoholic liver cirrhosis.

Salmonella dublin is a veterinary pathogen which rarely causes human illness, although reported human isolates have increased over the past two decades. This serovar of salmonella is unusually invasive and life-threatening, although the clinical pattern of human infection is not well known. We describe a 51-year-old cirrhotic patient who presented with severe liver failure, chronic diarrhoea and left-sided segmental colitis. Radiological and endoscopic findings suggested Crohn's colitis. During the hospital stay he developed a spontaneous bacterial peritonitis (SBP) and S. dublin was isolated in the ascitic fluid. Our report supports the view that this salmonella serovar should be kept in mind as a rare cause of SBP in cirrhotic patients, especially in those cases with chronic colitis resembling Crohn's disease.

[Non-steroidal anti-inflammatory drugs and cyclooxygenase-2 selectivity in gastroenterology]. / Los antiinflamatorios no esteroideos y selectividad sobre la ciclooxigenasa tipo II en Gastroenterología.

The discovery of, at least, two isoforms of the enzyme cyclooxygenase, named by the numbers 1 and 2, has updated our knowledge about the NSAID. This has led investigators to reconsider what we can expect from this kind of drugs. The two isoforms share enzymatic and structural properties, although they are regulated differently, at molecular level and can be distinguished from their functions, although an overlap of roles between them do exist. The main goal of the development of highly selective inhibitors is to improve gastric tolerability. The classical NSAID inhibit preferentially the isoform 1 of the cyclooxygenase, in vitro, which appears to be dangerous, according to gastrointestinal safety profile. The new compounds with high selectivity for the isoform 2 of the cyclooxygenase could be better tolerated at gastrointestinal level. Meanwhile these compounds also could have a potential use in several diseases such as colorectal cancer and neurodegenerative processes. The potential occurrence of side effects, perhaps related with renal function, should be noted. Finally large controlled clinical trials are needed to estimate the therapeutic advantages which can be offered by the new highly selective NSAID, and the potential consequences which can result from the isoform 2 of the cyclooxygenase prolonged inhibition