[Klippel-Feil syndrome, a rare cervicalgia]. / Síndrome de Klippel-Feil, una cervicalgia poco frecuente.

Cervicalgia is defined as the presence of pain in the neck region, and can radiate to the shoulders, upper limbs or back. It is a source of frequent visits to Primary Care, and more than half of the general population will suffer neck pain at some point in their life. Klippel-Feil syndrome is an exceptional cause of cervicalgia. It belongs to the group of so-called malformations of the hold-down skull-cervical congenital disease. Klippel-Feil syndrome is a complex disease entity characterized by the fusion of two or more vertebrae, and may also be associated with other bone and visceral disorders. The characteristic clinical triad consists of short-neck, implantation below the hair in the occipital region, and limitation of cervical mobility. However, this clinical picture is present in less than 50% of these patients.

Síndrome de Klippel-Feil, una cervicalgia poco frecuente / Klippel-Feil syndrome, a rare cervicalgia

La cervicalgia se define por la presencia de dolor en la región del cuello, pudiendo irradiarse o no a hombros, miembros superiores y/o espalda. Representa un motivo de consulta frecuente en atención primaria: más de la mitad de la población general presentará en algún momento de su vida dolor cervical. El síndrome de Klippel-Feil es una causa excepcional de cervicalgia. Es una enfermedad congénita del grupo de las denominadas malformaciones de la charnela craneocervical. Es una entidad nosológica compleja caracterizada por la fusión de 2 o más vértebras, pudiendo asociar también otras malformaciones y alteraciones óseas y viscerales. La tríada clínica característica consiste en cuello corto, implantación baja del cabello en la región occipital y limitación de la movilidad cervical. No obstante, dicha clínica está presente en menos del 50% de los pacientes (AU)

We present the case of a patient with chronic low back pain with an unfavourable progression despite the prescribed pharmacological treatment. The patient had symptoms associated with compression of the sciatic nerve in an atypical area. As it passed through the piriformis muscle, it was diagnosed as piriformis muscle syndrome. This diagnosis was based on the clinical signs and symptoms and the determination of the tests performed, with the imaging tests being absolutely normal. Treatment is basically with non-steroidal anti-inflammatory drugs, muscle relaxants and stretching exercises of this muscle (AU)

Esofagitis candidiásica en una paciente inmunocompetente. A propósito de un caso / Candida esophagitis in an immunocompetent woman. A case report

La esofagitis candidiásica (EC) es una de las formas invasivas de candidiasis. Su prevalencia diagnosticada mediante endoscopia digestiva alta oscila entre 0,77-2,4%. Su principal causa es la Candida albicans (CA). La EC afecta con mayor frecuencia a sujetos inmunodeprimidos, aunque también puede aparecer en sujetos sanos. Precisa tratamiento antifúngico sistémico. Presentamos el caso de una EC en una paciente sana con buena respuesta al tratamiento pautado, potencialmente relacionado con la toma de omeprazol por parte de la paciente (AU)

Candida esophagitis (CE) is one of the invasive infections caused by Candida albicans (CA). Its prevalence diagnosed by upper endoscopy ranges between 0.77-2.4%. Its main cause is CA. CE more often affects immunocompromised people, however it may affect healthy people too. CE requires systemic antifungal therapy. We report a case of a CE in a healthy woman who presented good response to prescribed treatment. Omeprazole might be involved in the development of her CE (AU)

[Candida esophagitis in an immunocompetent women. A case report]. / Esofagitis candidiásica en una paciente inmunocompetente. A propósito de un caso.

Candida esophagitis (CE) is one of the invasive infections caused by Candida albicans (CA). Its prevalence diagnosed by upper endoscopy ranges between 0.77-2.4%. Its main cause is CA. CE more often affects immunocompromised people, however it may affect healthy people too. CE requires systemic antifungal therapy. We report a case of a CE in a healthy woman who presented good response to prescribed treatment. Omeprazole might be involved in the development of her CE.

Síndrome de Mirizzi, una causa infrecuente de ictericia obstructiva / Mirizzi Syndrome, a rare cause of obstructive jaundice

El dolor abdominal es un motivo de consulta muy frecuente en atención primaria. La variabilidad de entidades nosológicas que presenta complica su diagnóstico diferencial. Las principales causas de dolor en hipocondrio derecho son biliares (cólico biliar, colecistitis y colangitis). El síndrome de Mirizzi es una complicación que aparece en aproximadamente el 1% de los pacientes con colelitiasis. Consiste en la impactación de un cálculo en el infundíbulo de la vesícula o el conducto cístico que comprime el conducto hepático común, pudiendo erosionarlo y generar una fístula colecisto-coledociana. Cursa clínicamente como ictericia obstructiva, asociándose frecuentemente a cáncer de vesícula. Se diagnostica mediante ecografía abdominal, confirmándose mediante colangiopancreatografía retrógrada endoscópica, colangiografía percutánea o colangio-resonancia. Su tratamiento es quirúrgico, pudiendo realizarse por vía laparoscópica o abierta en función de su estadio (AU)

Abdominal pain is a common cause of consultation in primary care. The variability in disease conditions with this pain complicates differential diagnosis. The main causes of right upper quadrant pain are bile (biliary colic, cholecystitis and cholangitis). Mirizzi syndrome is a complication that occurs in approximately 1% of patients with cholelithiasis. It consists of the impaction of calculi in the neck of the gallbladder or cystic duct that compresses the common hepatic duct, which may erode and create a cholecystocholedochal fistula. It clinically appears as obstructive jaundice, frequently associated with gallbladder cancer. It is diagnosed by ultrasound, confirmed by endoscopic retrograde cholangiopancreatography, percutaneous cholangiography or resonance-cholangiopancreatography. Treatment is surgical and can be performed by laparoscopic or open surgery, depending on the staging (AU)

Valoración de la implantación en Atención Primaria de la guía de práctica clínica ERGE / Assessment of the implantation in primary care of the GERD clinical practice guideline

INTRODUCCIÓN. El objetivo de este estudio es valorar, entre los médicos de Atención Primaria, el grado de implantación de la guía de práctica clínica sobre el manejo del paciente con enfermedad por reflujo gastroesofágico (ERGE), y el manejo de la ERGE en su práctica clínica habitual. MATERIAL Y MÉTODOS. Estudio descriptivo transversal multicéntrico realizado con 503 médicos de Atención Primaria de España. Los centros de salud se seleccionaron mediante muestreo no probabilístico. Las variables del estudio se obtuvieron mediante un cuestionario sobre el manejo de la ERGE y su adecuación con la guía. RESULTADOS. El 75,35% (intervalo de confianza [IC] 95%: 71,34-79,06) de los médicos refiere conocer la guía y un 60,64% (IC 95%: 56,21-64,93) sigue sus recomendaciones. El 98,81% (IC 95%: 97,42-99,56) especifica la pirosis como síntoma típico y un 89,86% (IC 95%: 86,88-92,36) la regurgitación. El 64,61% (IC 95%: 60,26-68,79) inicia un tratamiento empírico. El 46,92% (IC 95%: 42,49-51,39) indicaría la gastroscopia para precisar el diagnóstico. El 98,21% (IC 95%: 96,63-99,18) inicia el tratamiento sin derivar al especialista. El 81,71% (IC 95%: 78,05-84,99) es derivado tras el fracaso terapéutico. El 85,69% (IC 95%: 82,32-88,63) utiliza los diversos inhibidores de bomba de protones como tratamiento inicial, y el 76,34% (IC 95%: 72,38-79,99) considera que existen diferencias en eficacia y rapidez de acción entre estos fármacos. CONCLUSIÓN. El 75,35% de los médicos de Atención Primaria en España conoce la guía de práctica clínica ERGE. Existe un alto nivel de adecuación del manejo diagnóstico y terapéutico a las recomendaciones de la guía (AU)

INTRODUCTION. This study aims to assess the degree ofimplantation and of GERD “clinical practice guideline” andthe management of the gastroesophageal reflux disease(GERD) management of the family physicians in their commonclinical practice.MATERIAL AND METHODS. A multicenter, cross-sectional,descriptive study conducted with 503 family physiciansof Spain. The Primary Care Centers were selected by nonrandomizedsampling. The study variables were obtainedwith a questionnaire on the management of GERD and its adjustmentwith the guideline.RESULTS. A total of 75.35% (95% CI: 71.34-79.06) of thefamily physicians state they have knowledge of the guideline,and 60.64% (95% CI: 56.21-64.93) follows its recommendations.Of these, 98.81% (95% CI: 97.42-99.56) specifyheartburn as the typical symptom and 89.86% (95% CI:86.88-92.36) regurgitation. Empirical treatment is begun by64.61% (95% CI: 60.26-68.79) of them.Upper gastrointestinal endoscopy would be indicated by46.92% (95% CI: 42.49-51.39) of them to confirm the diagnosis.A total of 98.21% (95% CI: 96.63-99.18) initiate thetreatment without asking the specialist for guidance and81.71% (95% CI: 78.05-84.99) refer the patient for specialistsurgery after therapeutic failure. Various proton pump inhibitorsare used as initial treatment by 85.69% (95% CI:82.32-88.63) and 76.34% (95% CI: 72.38-79.99) considerthat differences in effectiveness and rapidity of action existamong these drugs.CONCLUSIONS: A total of 75.35% of the family physiciansin Spain know the clinical practice guideline GERD.There is a high level of adjustment between diagnostic andtherapeutic management and the recommendations of theguideline (AU)

[Study of unmatched cases and controls: hyperhomocysteinaemia and chronic ischaemic cardiopathy]. / Estudio de casos y controles no emparejados: hiperhomocisteinemia y cardiopatía isquémica crónica.

OBJECTIVE: To evaluate the extent of the association between hyperhomocysteinaemia and chronic ischaemic heart disease. DESIGN: Unmatched, case-control (1:3) study. SETTING: Pintores Health Centre, Area 10, Primary Care, Madrid, Spain. PARTICIPANTS: Patients of the health centre over 35 with chronic ischaemic heart disease or without it. METHOD: Consecutive, non-randomized sample. Analysis of cases and controls with chi2 test and odds ratio (OR). The quantitative variables were analysed with the Student's t test. RESULTS: The 76.32% (87/114) of cases had 2 or more cardiovascular risk factors versus 33.56% (99/265) in the control group (P<.0001). Average homocysteinaemia was 10.07 micromol/L (SD, 3.64) in the control group; and 12.74 (SD, 4.59) in the cases group. The difference between the averages (2.67 micromol/L; 95% CI, 1.82-3.52) was significant (P<.001). The difference (16.07%; 95% CI, 6.91-25.23) in hyperhomocysteinaemia (> or =15 micromol/L) between cases (28.95%, 33/114) and controls (12.88%, 38/295) was significant (P=.0001), with an association between hyperhomocysteinaemia and chronic ischaemic heart disease (OR=2.76; 95% CI, 1.62-4.68). This association increased (OR=3.26; 95% CI, 2.07-5.13) when hyperhomocysteinaemia was taken as > or =12 micromol/L, with a significant difference of 27% (95% CI, 16.59-37.41) (P<.0001) between cases (51.75%, 59/114) and controls (24.75%, 73/295). CONCLUSIONS: The risk factor of hyperhomocysteinaemia > or =15 micromol/L was significantly associated (OR=2.76) with chronic ischaemic heart disease. This association was greater (OR=3.26) when hyperhomocysteinaemia was taken as > or =12 micromol/L.

Estudio de casos y controles no emparejados: hiperhomocisteinemia y cardiopatía isquémica crónica / Study of unmatched cases and controls: hyperhomocysteinaemia and chronic ischaemic cardiopathy

Objetivo. Evaluar la magnitud de la asociación entre la hiperhomocisteinemia y la cardiopatía isquémica crónica. Diseño. Estudio de casos y controles no emparejados (1:3). Emplazamiento. Centro de Salud Pintores. Área 10 de Atención Primaria (IMSALUD). Participantes. Pacientes del centro de salud mayores de 35 años con cardiopatía isquémica crónica o sin ella. Método. Muestreo no probabilístico consecutivo. Análisis de casos y controles mediante la odds ratio (OR) y el test de la *2. Las variables cuantitativas se analizaron con el test de la t de Student. Resultados. El 76,32% (87/114) de los casos tenía 2 o más factores de riesgo cardiovascular, frente a un 33,56% (99/265) de los controles (p = 15 µmol/l) entre los casos (28,95%; 33/114) y los controles (12,88%; 38/295) fue significativa (16,07%; IC del 95%, 6,91-25,23) (p = 0,0001), con una asociación entre la hiperhomocisteinemia y la cardiopatía isquémica crónica (OR = 2,76; IC del 95%, 1,62-4,68]). Esta asociación aumentaba (OR = 3,26; IC del 95%, 2,07-5,13) al considerar la hiperhomocisteinemia >= 12 µmol/l, con una diferencia significativa del 27% (IC del 95%, 16,59-37,41; p = 15 µmol/l estaba asociado significativamente (OR = 2,76) con la cardiopatía isquémica crónica. Esta asociación era mayor (OR = 3,26) al considerar la hiperhomocisteinemia >= 12 µmol/l

Objective. To evaluate the extent of the association between hyperhomocysteinaemia and chronic ischaemic heart disease. Design. Unmatched, case-control (1:3) study. Setting. Pintores Health Centre, Area 10, Primary Care, Madrid, Spain. Participants. Patients of the health centre over 35 with chronic ischaemic heart disease or without it. Method. Consecutive, non-randomized sample. Analysis of cases and controls with *2 test and odds ratio (OR). The quantitative variables were analysed with the Student's t test. Results. The 76.32% (87/114) of cases had 2 or more cardiovascular risk factors versus 33.56% (99/265) in the control group (P=15 µmol/L) between cases (28.95%, 33/114) and controls (12.88%, 38/295) was significant (P=.0001), with an association between hyperhomocysteinaemia and chronic ischaemic heart disease (OR=2.76; 95% CI, 1.62-4.68). This association increased (OR=3.26; 95% CI, 2.07-5.13) when hyperhomocysteinaemia was taken as >=12 µmol/L, with a significant difference of 27% (95% CI, 16.59-37.41) (P=15 µmol/L was significantly associated (OR=2.76) with chronic ischaemic heart disease. This association was greater (OR=3.26) when hyperhomocysteinaemia was taken as >=12 µmol/L

Estudio de casos y controles no emparejados: seropositividad de anticuerpos frente a Chlamydia pneumoniae y cardiopatía isquémica crónica / Unmatched case-control study: seropositivity for antibodies to Chlamydia pneumoniae and chronic coronary heart disease

Introducción. La participación de las infecciones en el desarrollo de la placa ateromatosa es una cuestión de actualidad. El objetivo del estudio es evaluar la magnitud de la asociación entre la seropositividad de anticuerpos frente a Chlamydia pneumoniae y la cardiopatía isquémica crónica. Pacientes y métodos. Muestreo no probabilístico consecutivo de pacientes mayores de 35 años con cardiopatía isquémica crónica (99 casos) o sin ella (268 controles) del Centro de Salud Pintores, Área 10 Atención Primaria (IMSALUD). Análisis de casos y controles no emparejados (1:3) con determinación de odds ratio (OR) y sus intervalos de confianza. Determinación de anticuerpos IgG frente a C. pneumoniae con valores >= 1:64 mediante ELISA. Resultados. Un 75,76% (75/99) de los casos tenía 2 o más factores de riesgo cardiovascular, frente a un 33,21% (89/268) en los controles (p < 0,0001). Los factores de riesgo en los casos y controles mostraban diferencias significativas: tabaquismo (18,42%; intervalo de confianza [IC] del 95%: 7,10-28,41; p = 0,0012), hipertensión arterial (14,71%; IC del 95%: 3,39-26,03; p = 0,0124), diabetes (15,44%; IC del 95%: 6,01-24,87; p = 0,0002), hipercolesterolemia (52,08%; IC del 95%: 42,62-62,54; p < 0,0001). La diferencia de seropositividad de anticuerpos frente a C. pneumoniae entre casos (62,63% [62/99]) y controles (49,25% [132/268]) fue del 13,38% (IC del 95%: 2,13-24,63), con una asociación significativa (OR = 1,73; IC del 95%: 1,08-2,77; p = 0,0227) entre seropositividad y cardiopatía isquémica crónica. Conclusiones. La seropositividad frente a C. pneumoniae en los casos estudiados fue del 62,63%. El factor de riesgo de seropositividad frente a C. pneumoniae estaba asociado significativamente con la cardiopatía isquémica crónica (AU)

Introduction. The role of infections in the development of atheromatous plaque is a current topic. The objective of this study was to evaluate the magnitude of association between seropositivity for Chlamydia pneumoniae antibodies and chronic coronary heart disease. Patients and methods. Consecutive nonrandomized sampling was performed in patients aged more than 35 years old with (99 cases) or without (268 controls) chronic coronary heart disease attending the Centro de Salud Pintores, Primary Care Area 10 (Health Institute of Madrid, Spain). We performed an unmatched case-control study (1:3) with determination of odds ratio (OR) and their confidence intervals. C. pneumoniae antibodies (IgG >= 1:64) were determined by enzyme-linked immunosorbent assay. Results. A total of 75.76% (75/99) of cases had two or more cardiovascular risk factors (CRF) versus 33.21% (89/268) of the control group (p < 0.0001). The CRF in cases and controls showed significant differences: smoking (18.42%; 95% confidence interval [CI]: 7.10-28.41; p = 0.0012), hypertension (14.71%; 95% CI: 3.39-26.03; p = 0.0124), diabetes (15.44%; 95% CI: 6.01-24.87; p = 0.0002), and hypercholesterolemia (52.08%; 95% CI: 42.62-62.54; p < 0.0001). The difference in seropositivity to C. pneumoniae between cases (62.63% [62/99]) and controls (49.25% [132/268]) was 13.38% (95% CI: 2.13-24.63), with a significant association (OR = 1.73; 95% CI: 1.08-2.77; p = 0.0227) between seropositivity and chronic coronary heart disease. Conclusions. Seropositivity to C. pneumoniae IgG-antibodies was found in 62.63% of cases and was significantly associated with chronic coronary heart disease (AU)

[Current status of oral anticoagulation control in primary care]. / Situación actual del control de la anticoagulación oral en atención primaria.

OBJECTIVE: To know the present situation about the follow-up of the patients with oral anticoagulant therapy (OAT) in primary care centers, the difficulties felt in its implantation and the professionals attitudes. DESIGN: Cross-sectional descriptive study. SETTING: All Spanish primary care centers. PARTICIPANTS: The study subjects are the managers of all primary care centers. We selected a sample of 227 centers (the total number is 1854), for prevalence of 50%, confidence at 95%, precision 7% and 30% loss. The sample is stratified by regions. MEASUREMENTS AND MAIN RESULTS: We sent a questionnaire by post to the managers of sample primary care centers. We sent a new mailing, after three months, to the "no answers". A rate of 72.7% answers were obtained. 23% of sample primary care centers do follow-up of OAT al less in a part of the patients. Reduced access to hospital is the only structural cause that it has influence significantly. The main problem to carry out this activity is coordination with Haematology reference service. CONCLUSIONS: One every four Spanish primary care centers make the follow-up of OAT, higher when primary care centers are far away from hospital. So, accessibility is the factor with more influence in the decision of carry out OAT follow-up. Coordination with haematology services is the main problem to solve.