Cistinuria: la recurrencia de lo excepcional / Cystinuria: the recurrence of the exceptional

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Manifestaciones neurológicas por déficit aislado de vitamina B12 / Neurological signs due to isolated vitamin B12 deficiency

El déficit aislado de vitamina B12 es una entidad propia de pacientes de edad avanzada y poco común en pacientes menores de 30 años, siendo la edad promedio entre los 60 y 70 años. Esto es debido a que la cobalamina de los alimentos que se separa de las enzimas de la carne por el ácido clorhídrico y la pepsina en el estómago, no se libera sobre todo en los pacientes ancianos, frecuentemente a causa de la aclorhidria. Por ello, el organismo es incapaz de liberar la cobalamina pero sí conserva la capacidad de absorber la vitamina B12 cristalina, que se encuentra en los preparados polivitamínicos. Otra causa son los fármacos que suprimen la producción de ácido gástrico. Las manifestaciones neurológicas del déficit de vitamina B12 pueden aparecer en pacientes con un hematocrito e índices eritrocitarios normales. Incluyen parestesias, pérdida de sensibilidad, fuerza en las extremidades y ataxia. Los reflejos pueden estar atenuados o exaltados. Los signos de Romberg y Babinsky pueden ser positivos, y con frecuencia disminuye la sensibilidad vibratoria y de posición. Los trastornos del comportamiento varían desde irritabilidad y pérdida de memoria hasta una demencia intensa. Es frecuente que estas manifestaciones no remitan completamente con el tratamiento Presentamos un caso de déficit aislado de vitamina 12 en una paciente de 27 años, que acudió a la consulta de Atención Primaria refiriendo, durante la anamnesis, lumbalgia y a la que le atribuye la pérdida de fuerza y sensibilidad que padecía, en hemicuerpo derecho de aparición lenta y progresiva acompañada de cefalea de 4 días de evolución (AU)

Isolated vitamin B12 deficiency is a common condition in elderly patients but uncommon in patients younger than 30 years, with an average age of onset between 60 and 70 years. This is because the dietary cobalamin, which is normally split by enzymes in meat in the presence of hydrochloric acid and pepsin in the stomach, is not released in the stomachs of elderly patients, usually due to achlorhydria. Although the body may be unable to release cobalamin it does retain the ability to absorb vitamin B12 in its crystalline form, which is present in multivitamin preparations. Other causes are due to drugs that suppress gastric acid production. Neurological signs of vitamin B12 deficiency can occur in patients with a normal haematocrit and red cell indices. They include paresthesia, loss of sensation and strength in the limbs, and ataxia. Reflexes may be slowed down or increased. Romberg and Babinsky signs may be positive, and vibration and position sensitivity often decreases. Behavoural disorders range from irritability and memory loss to severe dementia. The symptoms often do not fully respond to treatment. A case is presented of an isolated vitamin B12 deficiency in 27 year-old female patient who was seen in primary health care. During anamnesis she mentioned low back pain, to which she attributed the loss of strength and tenderness in the right side of the body, as well as the slow and progressive onset of accompanied headache for the previous 4 days (AU)

[Neurological signs due to isolated vitamin B12 deficiency]. / Manifestaciones neurológicas por déficit aislado de vitamina B12.

Isolated vitamin B12 deficiency is a common condition in elderly patients but uncommon in patients younger than 30 years, with an average age of onset between 60 and 70 years. This is because the dietary cobalamin, which is normally split by enzymes in meat in the presence of hydrochloric acid and pepsin in the stomach, is not released in the stomachs of elderly patients, usually due to achlorhydria. Although the body may be unable to release cobalamin it does retain the ability to absorb vitamin B12 in its crystalline form, which is present in multivitamin preparations. Other causes are due to drugs that suppress gastric acid production. Neurological signs of vitamin B12 deficiency can occur in patients with a normal haematocrit and red cell indices. They include paresthesia, loss of sensation and strength in the limbs, and ataxia. Reflexes may be slowed down or increased. Romberg and Babinsky signs may be positive, and vibration and position sensitivity often decreases. Behavoural disorders range from irritability and memory loss to severe dementia. The symptoms often do not fully respond to treatment. A case is presented of an isolated vitamin B12 deficiency in 27 year-old female patient who was seen in primary health care. During anamnesis she mentioned low back pain, to which she attributed the loss of strength and tenderness in the right side of the body, as well as the slow and progressive onset of accompanied headache for the previous 4 days.

Utilización de automedida de la presión arterial y monitorización ambulatoria de la presión arterial por atención primaria en el municipio de Vigo / Self-blood pressure monitoring and ambulatory blood pressure monitoring in a primary care area in Spain

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Burnout en médicos de Atención Primaria de los centros de salud del municipio de Vigo / Burnout in Primary Care physicians of Health Care centers in Vigo municipality

Objetivos. Analizar el grado de desgaste profesional entre los médicos de Atención Primaria del municipio de Vigo. Material y Método. Diseño: estudio descriptivo y transversal. Emplazamiento: municipio de Vigo, Atención Primaria, segundo y tercer trimestre 2007. Sujetos: médicos. Mediciones: adaptación española del Maslach Burnout Inventory, que valora: cansancio emocional, despersonalización y realización profesional. Resultados. Un 11,32% de las mujeres y un 6,25% de los hombres encuestados presentan a la vez un nivel bajo de cansancio emocional y despersonalización, y un alto valor de realización personal. El porcentaje de respuestas a la encuesta realizada es del 44,88%. Conclusiones. Igual que otros estudios sobre burnout, aparece un alto nivel de cansancio emocional (61,38%) y despersonalización (54,45%) (AU)

Objectives. Analyze the degree of professional burnout among Primary Care physicians in the Vigo municipality. Material and methods: Design: descriptive, cross-sectional study. Site: municipality of Vigo, primary care, second and third quarter of 2007. Subjects: physicians. Measurements: Spanish adaptation of the Maslach Burnout Inventory (MBI) that evaluates: emotional tiredness, depersonalization and performance achievement (PA). Results: A total of 11.32% of women and 6.25% of men surveyed had a low level of emotional tiredness and depersonalization, and a high value of personal achievement. Response percentage to the survey was 44.88%. Conclusions: As in other studies on burnout, there is a high level of emotional tiredness (61.38%) and depersonalization (54.45%) (AU)

Calidad asistencial y evaluación de un programa de seguimiento farmacoterapéutico en anticoagulación oral por un equipo multidisciplinar de Atención Primaria de Salud / No disponible

Objetivo: Objetivo principal: evaluar un programa de terapia anticoagulante oral. Objetivos secundarios: determinar la prevalencia, aceptación por los pacientes, y grado de cobertura del control de anticoagulación oral por el equipo multidisciplinar con incorporación del farmacéutico de Atención Primaria. Cuantificar y clasificar los Problemas Relacionados con los Medicamentos y causas. Diseño: Estudio descriptivo transversal. Marco temporal: tres primeros meses de 2003. Emplazamiento: Unidad de Atención Primaria del Rosal (Pontevedra). Cobertura: 5.596 usuarios. Participantes: Se incluyeron los 49 pacientes adscritos al centro que recibían tratamiento con anticoagulantes orales. Criterio de exclusión: pacientes que no hubiesen realizado ningún control durante el período de estudio o que hubiesen rechazado el seguimiento farmacoterapéutico. Método: Se recogieron datos sobre características basales, indicaciones para terapia anticoagulante oral, Coeficiente internacional normalizado y Problemas Relacionados con Medicamentos. Determinación del Coeficiente internacional normalizado mediante técnica de química seca en sangre capilar. Se consideran rangos de referencia los establecidos por hospital de referencia. Análisis estadístico: las variables cuantitativas se expresaron como media±desviación estándar, variables cualitativas como frecuencias (porcentajes). Resultados: Prevalencia: 8,75 por mil. Grado de cobertura: 93,88%. El 63,6% de determinaciones en rango: INR=2,5±0,5 y 81,0% con INR=2,5±0,75. Se detectaron 53 PRM, 17% por medicamentos distintos a anticoagulantes orales. Causas: 32,07% por ajuste de dosis, 24,53% por interacción, 9,43% por incumplimiento y 5,66% por frecuencia o modo de administración inadecuado. Conclusiones: Adecuado control de terapia anticoagulante oral por el equipo multidisciplinar. Además de los anticoagulantes orales, otros medicamentos provocan Problemas Relacionados con los Medicamentos en proporción considerable (AU)

Objective: Main objective: to evalue therapeutic control of anticoagulant treatment. Secondary objective: to determine prevalence, acceptance by patients and control of oral anticoagulant treatment by the equipment with the incorporation of the primary care pharmacist. Cuantity and classify the drug related problems and their causes. Designe: Cross-sectional descriptive study. Three first months, 2003. Setting: O Rosal primary care center. Cover: 5596 users. Participants: 49 patients appointed to the center where they received the treatment were included. Patients who had not made any control during the period of the study or rejected the pharmaceutical care were exclused. Method: Data over patient baseline characteristics, indications for anticoagulant treatment and drug related problems. Determination of International Normalized Ratio (INR) by dry chemist in capillary blood. Referency ranks were considered the ones stablised by reference hospital. Statistic analysis: cuantitative variables were expressed as m±SD cualitative variables as frecuency (percentage). Results: Prevalence 8,75% per thousand. Cover degree: 93,88%. 63,6% of determinations in rank: INR=2,5±0,5 and 81,0% with INR=2,5±0,75. Were detected 53 drug related problems, 17 by drugs diferents to anticoagulant treatment. Cause: 32,07 by dosage adjustment, 24,53% by interaction, 9,43% by non compliance and 5,66% by frecuency or administration. Conclusions: Sustable control of anticoagulant treatment by the multidisciplinary equipment. Even anticoagulants other drugs cause drug related problems in a considerable frecuency (AU)

[The treatment of children with non-migrainous headaches]. / Tratamiento de los niños con cefaleas no migrañosas.

AIMS: The purpose of our study is to review non-migrainous headaches (NMH), the pain mechanisms and their treatment, with emphasis on the author's clinical experience. DEVELOPMENT: Headaches are commonplace in the daily practice of Paediatrics. About 22% of new patients who came to the Neuropaediatric department as outpatients presented headaches as the reason for their visit. Whenever there is a headache, there must be some pain mechanism involved. These mechanisms are vasodilatation, inflammation, traction and displacement of intracranial structures, sustained muscular tension, or some neurogenic mechanism. Clinical evaluation enables us to diagnose the type of headache and to treat it. Physical and neurological explorations are normal in most children with headache. The classification of syndromes includes acute generalized headache, acute localized headache, acute recurring headache, chronic progressive headache and chronic non-progressive (recurring) headache. Recurring headaches occur frequently in children and are more readily diagnosed from clinical data than by examinations. Routine use of any diagnostic study provides no indication of when the clinical history has no associated risk factors and the examination of the child is normal. Therapy is based on the type of headache. Most headaches in children are due to a vascular mechanism. The author advocates the use of a dietetic treatment in association with the intake of small amounts of caffeine BID. CONCLUSIONS: The treatment of NMH depends on the kind of syndrome presented but, for the most part, it is very satisfactory for both the patients and their parents.

Tratamiento de los niños con cefaleas no migrañosas / The treatment of children with non-migrainous headaches

Objetivo. Revisar las cefaleas no migrañosas (CNM), los mecanismos del dolor y su tratamiento, con énfasis en la experiencia clínica del autor. Desarrollo. Las cefaleas son comunes en la práctica diaria de la pediatría. Aproximadamente el 22 por ciento de los nuevos pacientes vistos en una consulta externa de neuropediatría presentan cefalea como motivo de consulta. Siempre que exista cefalea, debe estar involucrado algún mecanismo de dolor. Estos son: vasodilatación, inflamación, tracción y desplazamiento de estructuras intracraneales, tensión muscular sostenida y mecanismo neurogénico. La evaluación clínica nos permite diagnosticar el tipo de cefalea y realizar su tratamiento. Los exámenes físico y neurológico son normales en la mayoría de los niños con cefalea. La clasificación sindrómica incluye: cefalea aguda generalizada, cefalea aguda localizada, cefalea aguda recurrente, cefalea crónica progresiva, cefalea crónica (recurrente) no progresiva. Las cefaleas recurrentes ocurren comúnmente en niños y se diagnostican más bien sobre una base clínica que por exámenes. El uso rutinario de cualquier estudio diagnóstico no está indica cuando la historia clínica no tiene factores de riesgo asociados y el examen del niño es normal. El tratamiento se basa en el tipo de cefalea existente. La mayoría de las cefaleas en los niños tienen un mecanismo vascular. El autor se inclina por un tratamiento dietético asociado con la ingesta diaria de una pequeña dosis de cafeína BID. Conclusiones. El tratamiento de las CNM depende del tipo de síndrome existente, pero en su gran mayoría, es muy satisfactorio para los pacientes y sus padres (AU)

Aims. The purpose of our study is to review non-migrainous headaches (NMH), the pain mechanisms and their treatment, with emphasis on the author’s clinical experience. Development. Headaches are commonplace in the daily practice of Paediatrics. About 22% of new patients who came to the Neuropaediatric department as outpatients presented headaches as the reason for their visit. Whenever there is a headache, there must be some pain mechanism involved. These mechanisms are vasodilatation, inflammation, traction and displacement of intracranial structures, sustained muscular tension, or some neurogenic mechanism. Clinical evaluation enables us to diagnose the type of headache and to treat it. Physical and neurological explorations are normal in most children with headache. The classification of syndromes includes acute generalized headache, acute localized headache, acute recurring headache, chronic progressive headache and chronic non-progressive (recurring) headache. Recurring headaches occur frequently in children and are more readily diagnosed from clinical data than by examinations. Routine use of any diagnostic study provides no indication of when the clinical history has no associated risk factors and the examination of the child is normal. Therapy is based on the type of headache. Most headaches in children are due to a vascular mechanism. The author advocates the use of a dietetic treatment in association with the intake of small amounts of caffeine BID. Conclusions. The treatment of NMH depends on the kind of syndrome presented but, for the most part, it is very satisfactory for both the patients and their parents (AU)