Enfoque diagnóstico del paciente con rubor facial transitorio en atención primaria / A Diagnostic Approach of Patient with Flushing in Primary Care

El rubor facial transitorio se define como una sensación de calor, acompañada de enrojecimiento de la piel, causada por una respuesta vasomotora con el resultante incremento en el flujo sanguíneo regional, debido a la acción directa de diferentes mediadores liberados por los nervios. Los cuadros pueden ser episódicos o constantes y se relacionan con respuestas fisiológicas y con patologías de origen benigno y maligno. El objetivo de la revisión es realizar un abordaje racional de esta condición en el escenario de atención primaria, con el fin de llegar a un diagnóstico precoz y completo, abordando los principales diagnósticos diferenciales asociados con esta condición.

The definición of flushing involves a sensation of heat along with redness of the skin, caused by vasomotor influx resulting in an increased of the regional vascular blood flow due to the direct action of different mediators through the vasomotor nerves. These symptoms can be episodio or repetitive and they' can be related to benign or malignant conditions. The objective of this review is to develope a racional approach of the condition at primary care, with the purpose of an early and complete diagnosis, covering the main differential diagnosis related to this condition.

[Discriminative capacity of a simple question as a screening for hazardous and harmful alcohol consumption in a university medical service]. / Capacidad discriminativa de una pregunta simple como instrumento de tamizaje para el consumo nocivo de alcohol en un servicio médico universitario.

INTRODUCTION: Alcohol misuse has been recognized as a public health problem in universities. It is possible to achieve a preventive approach if early identification of people with risky and harmful drinking patterns is achieved. There are multiple screening instruments with acceptable sensitivity. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has recommended the use of a simple question to screen hazardous and harmful alcohol consumption in primary care and their incorporation into routine clinical practice. OBJECTIVE: To determine the discriminative ability of a simple question as a screening in a student health service. METHODS: We applied this question to 303 patients treated at a university medical service, followed by the AUDIT. RESULTS: Using AUDIT as a reference, the sensitivity and specificity of the simple question to detect hazardous and harmful alcohol consumption was 0.90 (95% CI: 0.68-0.98) and 0.76 (95% CI: 0.70-0.80), respectively, with a negative predictive value of 99.1%. CONCLUSIONS: The simple question can timely detect people with risky and harmful alcohol consumption in a university medical service. This requires implementing a systematic approach to timely identify and intervene in this problem.

Terapia farmacológica para el abandono del tabaquismo / Pharmacological treatment for smoking cessation

El tabaquismo es una enfermedad crónica causada por la dependencia física y psicológica a la nicotina y es la principal causa de mortalidad prevenible. La disponibilidad de productos derivados del tabaco y su aceptación social produce un elevado consumo en la población general. El problema del tabaquismo resulta paradójico: presenta alta prevalencia, altas tasas de mortalidad y altos costos para el sistema de salud; sin embargo, a pesar de disponer de múltiples opciones de tratamiento costo-efectivos, el equipo de salud está escasamente capacitado y motivado para la intervención, y no se cuenta con centros especializados ni con cobertura para los tratamientos de suspensión o abandono. El tratamiento farmacológico para el cese del tabaquismo siempre debe ser parte de una estrategia organizada, interdisciplinaria y multifactorial, cuya prescripción debe hacerse en el momento evolutivo adecuado de cada paciente, según el estado de dependencia en que se encuentre. En el presente artículo se presenta una revisión de la terapia farmacológica para abandonar la adicción al tabaco.

Smoking is a chronic disease due to physical and psychological nicotine dependence and remains as the leading cause of preventable mortality. Availability of tobacco products and social approval has a great impact on consumption in the general population. Smoking is a paradoxical problem. Although multiple cost-effective therapies are available, health practitioners are barely trained or motivated to treat these patients. Appropriate specialized centers and health coverage for its management are also lacking. Pharmacological therapy must be a part of an organized, interdisciplinary and multifactorial strategy, prescribed in an adequate stage of change. This article is a review of the pharmacological treatment for smoking cessation.