Síndrome de Poland: a propósito de un caso / Poland syndrome: presentation of a case

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Atrofia e hipopigmentación cutánea secundaria a infiltración / Cutaneous atrophy and hypopigmentation secondary to intra-articular corticosteroid injection

La epicondilitis es la enfermedad más frecuente del codo. Se trata de una tendinitis producida en la mayoría de los casos por los movimientos repetitivos de los músculos extensores del antebrazo y pertenece al grupo de enfermedades ocupacionales que se relacionan con la actividad laboral o deportiva. Las inyecciones intraarticulares de glucocorticoides son utilizadas frecuentemente por dermatólogos, reumatólogos, traumatólogos y en atención primaria por su fácil administración, sin embargo esta técnica no está exenta de efectos adversos, existiendo un número limitado de informes de casos que describen atrofia e hipopigmentación cutánea como efecto secundario. Las indicaciones para las infiltraciones generales con glucocorticoides son: enfermedad inflamatoria monofocal u oligofocal articular o de tejidos blandos, enfermedad inflamatoria polifocal, pero con mayor severidad monofocal u oligofocal, insuficiencia del tratamiento farmacológico y/o rehabilitador y cuando estén contraindicados otros tratamientos (AU)

Epicondylitis is the most common disease of the elbow. It is a tendinitis caused, in most cases, by repetitive motion of the forearm extensor muscles, and belongs to the group of occupational diseases that are related to work activity or sport. Intra-articular injections of glucocorticoids are often used by dermatologists, rheumatologists, orthopaedic surgeons, and primary care due to their ease of administration. However, this procedure has potential side effects. There are a limited number of case reports describing atrophy and hypopigmentation of the skin as a side effect. The general indications for glucocorticoid injections are monofocal and multifocal inflammatory disease, multifocal articular or soft tissue disease. It is more often used in more severe monofocal or multifocal inflammation, failure of drug treatment and/or rehabilitatory when other treatments are contraindicated (AU)

[Cutaneous atrophy and hypopigmentation secondary to intra-articular corticosteroid injection]. / Atrofia e hipopigmentación cutánea secundaria a infiltración.

Epicondylitis is the most common disease of the elbow. It is a tendinitis caused, in most cases, by repetitive motion of the forearm extensor muscles, and belongs to the group of occupational diseases that are related to work activity or sport. Intra-articular injections of glucocorticoids are often used by dermatologists, rheumatologists, orthopaedic surgeons, and primary care due to their ease of administration. However, this procedure has potential side effects. There are a limited number of case reports describing atrophy and hypopigmentation of the skin as a side effect. The general indications for glucocorticoid injections are monofocal and multifocal inflammatory disease, multifocal articular or soft tissue disease. It is more often used in more severe monofocal or multifocal inflammation, failure of drug treatment and/or rehabilitatory when other treatments are contraindicated.

[Iatrogenic adrenal insufficiency]. / Insuficiencia suprarrenal iatrogénica.

Adrenal insufficiency is a disease caused by the deficit in production and/or secretion of glucocorticoids. The aetiology of Adrenal Insufficiency (AI) can be classified into primary and secondary, and it should be taken that the incidence and prevalence of the secondary formare much higher than the primary form. One of the main causes of AI is due to prescription of exogenous steroids. It can be taken orally, which is more common, or topically. The latter is more uncommon but it should not be a a reason for ruling it out. We have to be aware when giving a topical treatment and to monitor the frequency our patients ask for the prescription.

Insuficiencia suprarrenal iatrogénica / Iatrogenic adrenal insufficiency

La insuficiencia suprarrenal (IS) es un síndrome causado por el déficit de producción y/o secreción de glucocorticoides. La etiología de la IS puede dividirse en primaria y secundaria, y debemos tener en consideración que la incidencia y la prevalencia de la secundaria son mucho mayores que las de la primaria. Una de las causas principales de IS es la administración exógena de esteroides que puede ser de forma oral, más generalizada, o bien de forma tópica. Esta última más infrecuente, pero no por ello hemos de olvidarla y debemos tenerla presente a la hora de administrar un tratamiento tópico y en pacientes que con frecuencia solicitan dicha medicación (AU)

Adrenal insufficiency is a disease caused by the deficit in production and/or secretion of glucocorticoids. The aetiology of Adrenal Insufficiency (AI) can be classified into primary and secondary, and it should be taken that the incidence and prevalence of the secondary formare much higher than the primary form. One of the main causes of AI is due to prescription of exogenous steroids. It can be taken orally, which is more common, or topically. The latter is more uncommon but it should not be a a reason for ruling it out. We have to be aware when giving a topical treatment and to monitor the frequency our patients ask for the prescription (AU)

Introducción de la monitorización ambulatoria de la presión arterial en el manejo de la hipertensión arterial en una consulta de Atención Primaria de ámbito rural / Introduction to ABPM in the managementof HBP in a rural primary health careconsultation

OBJETIVOS. El objetivo principal fue valorar la utilidad de la monitorización ambulatoria de la presión arterial (MAPA) en la toma de decisiones en el manejo de la hipertensión en la consulta de Atención Primaria, y el secundario disponer de una aproximación al perfil del ritmo circadiano de nuestros pacientes. MÉTODOS. Estudio descriptivo transversal mediante revisión de historias clínicas de las MAPA realizadas desde septiembre de 2004 hasta mayo de 2006 en una consulta de Atención Primaria de ámbito rural. RESULTADOS. Se estudiaron 124 MAPA. La edad media fue de 62,71 años, el 59,67% eran mujeres, la presión arterial sistólica (PAS) media fue 125,82 mmHg y la diastólica media 73,44 mmHg. Presentaban un perfil dipper el 44,35%. Con posterioridad a la MAPA se tomó decisión clínica en 71 pacientes (57,25%); de éstos se aumentó el tratamiento en 23 (32,4%), se disminuyó en 10 (14,1%), se realizó un cambio de horario en 31 (43,66%), se inició tratamiento en 7 (9,86%) y se desestimó el inicio de tratamiento por fenómeno de bata blanca en 13 (17,6%). CONCLUSIONES. La MAPA es un instrumento de gran ayuda en el manejo del paciente hipertenso crónico, facilita la toma de decisiones evitando el inicio de tratamientos innecesarios, la optimización de las dosis en pacientes ya conocidos con efecto de bata blanca en la consulta, y permite una aproximación al perfil circadiano de la presión arterial, para así considerar la cronoterapia como una opción terapéutica más para disminuir factores de riesgo cardiovascular

OBJECTIVES. Assess the utility of ambulatory blood pressure monitoring (ABPM) in decision making in the management of hypertension in the Primary Health Care consultation as a primary objective; secondary objective: have an approach to the profile of circadian rhythm of our patients. METHODS. Descriptive, cross-sectional study by review of clinical histories of the ABPMs conducted from September 2004 to May 2006 in a rural primary health care consultation. RESULTS. A total of 124 ABPMs were studied. Mean age was 62.71 years, 59.7% were women, mean systolic blood pressure (SBP) was 125.82 mmHg, mean dystolic 73.44 mmHg. They had a dipper profile of 44.35%. After the ABPM, clinical decision was made in 57.25%. Of these, treatment was increased in 23 of them (32.4%) and it decreased in 10 (14.1%). Time change was made in 31 patients (43.66%), treatment was initiated in 7 (9.86%) patients and beginning treatment was ruled out due to white coat phenomenon in 13 (17.6%). CONCLUSIONS. ABPM is a very useful instrument in the management of chronic hypertensive patient and facilitates decision-making, thus avoiding unnecessary initiation of treatments. It helps to optimize the doses in patients already known to have while coat effect in the consultation and allows for an approach to the circadian profile of blood pressure and to consider chronotherapy as one more therapeutic option to decrease cardiovascular risk factors

[Calculation of coronary risk in the 35-60 year old population registered at a health centre]. / Estimación del riesgo coronario en la población de 35-60 años adscrita a un centro de salud.

OBJECTIVES: To stratify the population between 35 and 60 years old according to their coronary risk (CR) and to identify the modifiable cardiovascular risk factors that affect our population. DESIGN: Transversal, descriptive study. SETTING: Cabañaquinta Health Centre, in a rural health district in Asturias area VII.Participants. Simple randomised sampling based on the health cards of the population between 35 and 60 years old assigned to a health centre. Total number of people included was 205, and 95 did not reply. MAIN MEASUREMENTS: The variables were: age, sex, total cholesterol, HDL-cholesterol, triglycerides, diastolic blood pressure, systolic blood pressure, tobacco dependency, diabetes, hypertension treatment, treatment for lipaemia, and personal background of cardiovascular disease (CVD). CR was calculated with the ATP-III tables (Adult Treatment Panel III). High CR was understood as over 20% likelihood of developing CVD or having recurrent episodes of CVD in the next 10 years. RESULTS: A simple descriptive study was conducted. 53% were women; mean age was 48. 37% were smokers, 27% with lipaemia and 29% with hypertension. Mean systolic pressure was 126 mm Hg, mean diastolic pressure was 80 mm Hg. Cholesterol was 213 mg/dL (confidence interval [CI], 174-252), HDL-cholesterol 52.64 mg/dL (CI, 39.94-65.34), LDL-cholesterol 139 mg/dL (CI, 104-174) and triglycerides 106.02 mg/dL (CI, 19.72-192.32). 45% of the sample had two or more CV risk factors. Mean CV risk in the population was 5.3% (CI, <1%-11.3%). According to the table used, 2% of the population had high CR. CONCLUSIONS: Most of our population had moderate risk. The most common group of patients is a young woman smoker with moderate risk. Tobacco is the most prevalent modifiable risk factor.

Estimación del riesgo coronario en la población de 35-60 años adscrita a un centro de salud / Calculation of coronary risk in the 35-60 year old population registered at a health centre

Objetivo. Estratificar la población entre 35 y 60 años según su riesgo coronario (RC) e identificar los factores de riesgo cardiovascular (FRCV) modificables que afectan a nuestra población. Diseño. Estudio descriptivo transversal. Emplazamiento. Centro de Salud de Cabañaquinta. Zona básica de salud rural del área VII de Asturias. Participantes. Muestreo aleatorio simple a partir de las tarjetas sanitarias de la población asignada a un centro de salud de entre 35 y 60 años de edad. El total de los sujetos incluidos fue de 205 y la tasa de no respuesta de 95.Mediciones principales. Las variables fueron: edad, sexo, colesterol total, cHDL, triglicéridos, presión arterial diastólica (PAD), presión arterial sistólica (PAS), tabaquismo, diabetes, tratamiento de hipertensión, tratamiento de dislipemias y antecedentes personales de enfermedad cardiovascular (ECV). Se calculó el RC con las tablas del ATP III (Adult Treatment Panel III). Un RC alto se definió como más de un 20 por ciento de probabilidad de desarrollar ECV o de tener episodios recurrentes de ECV en los próximos 10 años. Resultados. Se realizó un estudio descriptivo simple. El 53 por ciento de los participantes eran mujeres; la edad media era de 48 años. Un 37 por ciento de los pacientes eran fumadores, un 27 por ciento, dislipémicos y un 29 por ciento, hipertensos. La PAS media era de 126 mmHg y la PAD media de 80 mmHg. La cifra global de colesterol era de 213 mg/dl (intervalo de confianza [IC], 174-252), el cHDL de 52,64 mg/dl (IC, 39,94-65,34), el cLDL de 139 mg/dl (IC, 104-174) y los triglicéridos de 106,02 mg/dl (IC, 19,72-192,32). Un 45 por ciento de la muestra tenía dos o más factores de riesgo de RCV. El RCV medio de la población fue del 5,3 por ciento con (IC, < 1-11,3).Según la tabla utilizada, el 2 por ciento de la población tiene un RC alto. Conclusiones. La mayoría de nuestra población tiene un riesgo coronario moderado. El perfil más frecuente de los pacientes corresponde a una mujer joven, fumadora, con un riesgo coronario moderado, y el tabaco aparece como el factor de riesgo modificable más prevalente (AU)

[Functional ability in people above 80 years old]. / Capacidad funcional en mayores de 80 años.

OBJECTIVE: To discover the functional capacity (CF) for population over 80 years assing to an health center. DESIGN: This was an observational crossover study, using OARS questionary. SETTING: An urban health center. PATIENTS AND OTHER PARTICIPANTS: A sex and residence proportional sample of aged 80 and over was taken from 1986 census registry. MEASUREMENTS AND MAIN RESULTS: To asses functional capacity we used ADL (Activities of daily living) dimension from OARS questionry. It's composed of 14 items, seven for basic activities of daily living (AVDb) and seven for instrumental activities (AVDi). We considered severe incapacity if the aged had some difficulty in one AVDb at lest; moderate incapacity if the showed only a trouble in some AVDi, and good CF if didn't show the least difficulty in any item. The 42.2% of aged had severe incapacity, 26% of population had got good CF. The most incapacity was watched in house-works and cooking; in the AVDb were sphincters and control and cleaniless corporal. CONCLUSIONS: Functional capacity in population aged in the zone is lightly inferior to the other studies, however the ages chosen aren't comparable absolutely. We find differences in functional capacity between sex, the results are better for men. Population aged who is living in institutions have mainly CF moderate, and the married are more good functional capacity than singles or widows.

[Variation in blood pressure values in a pediatric population assigned to a primary care team by applying a correction factor according to brachial perimeter]. / Variación de las cifras de tensión arterial en una población infantil adscrita a un equipo de atención primaria al aplicar el factor de corrección según el perímetro braquial.

OBJECTIVE: To quantitative changes in blood pressure values and in hypertension diagnosis after applying a correction factor (CF) according to brachial perimeter. MATERIALS AND METHODS: A sample of 164 male and female children, aged 11-14 years from a population attended at our Health Institution was studied. Blood pressure and brachial perimeter at the right arm were determined in all children and the CF was applied according to brachial perimeter. RESULTS: Mean brachial perimeter was 23.8 cm, with a higher value in males (p < 0.05); a significant increase in blood pressure values was observed both for the overall sample and for both sexes taken separately; prevalence of hypertension increased significantly after correction of sample and for males, not for females. CONCLUSIONS: For an appropriate blood pressure measurement it is essential to correctly fit the cuff bladder size to the brachial perimeter; when it is not possible the CF should be applied.