[Attitudes toward the diagnosis of chronic obstructive pulmonary disease in primary care]. / Problemas con el diagnóstico de la EPOC en atención primaria.

OBJECTIVE: Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results. METHODS: A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated. RESULTS: COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09). CONCLUSIONS: There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk.

Problemas con el diagnóstico de la EPOC en atención primaria / Attitudes toward the diagnosis of Chronic Obstructive Pulmonary Disease in primary care

Objetivo: La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado en el sexo femenino, pero aún se considera una enfermedad que afecta sobre todo a los varones. Este estudio pretendió identificar las actitudes diagnósticas de los médicos de atención primaria frente a pacientes con EPOC según su sexo y los resultados de la espirometría. Método: Participó en el estudio una muestra representativa de 839 médicos de atención primaria. Cada uno de ellos resolvió uno entre 8 casos posibles de pacientes con EPOC. La mitad de éstos correspondía a un paciente varón y la otra mitad a una mujer con historia clínica y exploración física idénticas. Tras la historia y la exploración física se solicitó a los participantes un diagnóstico provisional, así como las pruebas diagnósticas necesarias. Se facilitaron después los resultados de la espirometría que mostraban una obstrucción de carácter moderado o grave. Los resultados negativos de una prueba broncodilatadora y de una prueba con corticoides orales se dieron a continuación. Resultados: La EPOC fue un diagnóstico provisional más probable para los pacientes varones que para las mujeres (odds ratio [OR]: 1,55; intervalo de confianza [IC] del 95%, 1,15-2,1). Este sesgo desaparecía después de mostrar los resultados anormales de la espirometría. Los pacientes con una obstrucción de carácter grave eran diagnosticados con mayor probabilidad de EPOC que aquellos con una obstrucción moderada OR: 1,5; IC del 95%, 1,08-2,09). Conclusiones: Existe un sesgo diagnóstico en función del sexo del paciente. En muchas ocasiones no se diagnostica a los pacientes con EPOC que presentan una obstrucción moderada. Estos sesgos podrían comprometer el diagnóstico precoz de la EPOC en un grupo cada vez más frecuente de individuos en riesgo

Objective: Although the prevalence of chronic obstructive pulmonary disease (COPD) has increased among women, it is still considered a disease that mainly affects men. This study aimed to identify the diagnostic attitudes of primary care physicians toward patients with COPD according to gender and spirometric results. Methods: A representative sample of 839 primary care physicians participated in the study. Each physician dealt with 1 of 8 hypothetical cases based on a patient diagnosed with COPD. In half the cases, the physician was told the patient was a man. The other half of the physicians were told the same patient was a woman. After presentation of the medical history and results of physical examination, the physicians were asked to state a probable diagnosis and indicate the diagnostic tests that were necessary. They were then told the results of spirometry, which indicated obstruction ranging from moderate to severe. Negative results of bronchodilator tests and oral corticosteroid tests were then communicated. Results: COPD was more likely to be the preliminary diagnosis for male patients than for females (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1). This gender bias disappeared once the physicians were shown the abnormal results of spirometry. Patients with severe obstruction were more likely to be diagnosed with COPD than those with moderate obstruction (OR, 1.5; 95% CI, 1.08-2.09). Conclusions: There is gender bias in the diagnosis of COPD. Patients with moderate obstruction are often believed not to have COPD. These biases may compromise the early diagnosis of the disease in a group of patients with ever increasing risk

Linfadenitis histiocitaria necrotizante (enfermedad de Kikuchi-Fujimoto) en niña de 7 años / Histiocytic nrcrotizing lymphadenitis (Kikuchi-Fujimoto's disease) in a 7-year-old girl

La enfermedad de Kikuchi-Fujimoto es una enfermedad rara y, por lo general, autolimitada que afecta generalmente a los ganglios cervicales de sujetos jóvenes y va asociada a un cuadro de fiebre elevada, rash cutáneo y alteraciones hematológicas. La biopsia de las adenopatías lleva al diagnóstico de linfadenitis necrotizante histiocitaria y permite diferenciarla de adenopatía de otros orígenes: infeccioso o tumoral. Presentamos el caso de una niña de 7 años afecta de enfermedad de Kikuchi-Fujimoto de localización cervical, que resulta la afectación más temprana de dicha enfermedad tras la revisión de la literatura realizada. Dada la escasa referencia de esta enfermedad en la edad pediátrica por su baja prevalencia, es necesario que, tanto el pediatra, como el cirujano pediátrico conozcan esta entidad para realizar un correcto diagnóstico y tratamiento de la misma.etiología desconocida, que suele afectar a mujeres jóvenes mayores de 18 años, produciendo un cuadro clínico autolimitado, con síndrome febril y afectación de las cadenas ganglionares laterocervicales, siendo su aparición en la edad pediátrica excepcional. Presentamos el cuadro clínico de una LHN en una niña de 7 años que es, tras la revisión efectuada por los autores, la afectación más temprana de dicha enfermedad con buena evolución (AU)

[Necrotizing histiocytic lymphadenitis (Kikuchi-Fujimoto disease) in a 7-year-old girl]. / Linfadenitis histiocitaria necrotizante (enfermedad de Kikuchi-Fujimoto) en niña de 7 años.

Kikuchi-Fujimoto's disease is a rare self-limited condition of young adults that usually involves the cervical lymph nodes and is associated with fever, rash and some haematological alterations. Diagnosis is based on characteristic pathologic findings that permit differentiation of this disease from lymphoma, systemic lupus erythematous and infectious lymphadenopathies. We describe a case of 7 year-old female presenting with cervical localization of Kikuchi-Fujimoto's disease. To our knowledge, this case results the earliest affection of this disease. Our proposal with this article is to remind the pediatricians and pediatric surgeons of this poorly recognized entity when children ask for cervical masses and fever.