Atencion Primaria Practica最新文献

{"title":"Calidad de la información en las historias clínicas de personas con diabetes mellitus tipo 2 sobre el cuidado de los pies en centros de atención primaria de salud de Ecuador","authors":"Hugo Pereira Olmos ,&nbsp;Karen Pesse Sorensen ,&nbsp;Alexandro Cruz Mariño ,&nbsp;Henry Johaner De Armas Toro ,&nbsp;Jemner Xavier Machuca Espinoza ,&nbsp;Erika Quishpe Narváez","doi":"10.1016/j.appr.2024.100213","DOIUrl":"10.1016/j.appr.2024.100213","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the quality of information recorded in medical records, with an emphasis on foot care guidance for people with type 2 diabetes mellitus.</div></div><div><h3>Design</h3><div>Cross-sectional multicenter study.</div></div><div><h3>Setting</h3><div>Four primary care centers in Ecuador.</div></div><div><h3>Participants</h3><div>Medical records of 489 randomly selected individuals with type 2 diabetes mellitus.</div></div><div><h3>Main measurements</h3><div>Outcome variable: recording of care in four sections of the medical record: anamnesis, physical examination, complementary tests, and comprehensive evaluation. Explanatory variables: health center, age, and sex. Proportions and adjusted odds ratios (OR) were calculated using logistic regression with their confidence intervals.</div></div><div><h3>Results</h3><div>Of the 489 medical records, 57.9% were women. Twenty-three percent had no record of medical control, 98.2% lacked a podiatric assessment, 3.1% included an eye fundus exam, 4.3% had an electrocardiogram, and 7.6% had a psychosocial interconsultation. Being an older adult was associated with a higher likelihood of recording comorbidities (OR = 1.9), foot physical examination (OR = 1.7), neurological evaluation (OR = 2.9), and complementary tests (creatinine OR = 1.5, cholesterol OR = 1.8).</div></div><div><h3>Conclusion</h3><div>The study reveals poor quality in the clinical information recorded for individuals with diabetes, especially in podiatric assessments and the ordering of complementary tests. Older adults showed more complete records, highlighting the need to improve the consistency of care and recording for all patients. It is crucial to implement strategies that strengthen foot care guidance and the integrity of clinical records in the management of diabetes.</div></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seroma de Morel-Lavallée: reporte de caso desde Manu, Perú, con diagnóstico y manejo en atención primaria","authors":"Percy J. Vásquez-Paredes","doi":"10.1016/j.appr.2024.100212","DOIUrl":"10.1016/j.appr.2024.100212","url":null,"abstract":"<div><div>The Morel-Lavallée lesion is a post-traumatic fluid accumulation between fascial layers, commonly following an accident. Its diagnosis is based on clinical history and imaging tests, and treatment ranges from conservative measures to surgical interventions and sclerotherapy, depending on the age and size of the lesion. Effective management is crucial to prevent long-term complications. This report presents a 38-year-old male who suffered a knee contusion from falling off his parked motorcycle, developing a fluctuating mass and moderate pain. Initially treated with paracetamol, the lesion grew to 7 x 7 x 5.5 cm, requiring medical attention. It was confirmed by radiography and surgically drained, releasing serohematic fluid. The treatment included rest, limb elevation, and NSAIDs, showing significant improvement. This case underscores the importance of early diagnosis and proper management of Morel-Lavallée lesions to prevent long-term complications.</div></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Situs inversus totalis: A case report from Somalia","authors":"Abdirahman Ibrahim Said ,&nbsp;Abdirahman Omer Ali ,&nbsp;Amtarahman Ibrahim Said ,&nbsp;Said Ibrahim Said ,&nbsp;Hassan Sh Abdirahman Elmi","doi":"10.1016/j.appr.2024.100211","DOIUrl":"10.1016/j.appr.2024.100211","url":null,"abstract":"<div><h3>Introduction</h3><div>Situs inversus totalis (SIT), a rare congenital disorder, involves complete reversal of the heart's position and mirrored arrangement of visceral organs. Early diagnosis is crucial for managing complications like transposition of the great vessels and Kartagener syndrome, marked by bronchiectasis and sinusitis due to ciliary dysfunction.</div></div><div><h3>Case presentation</h3><div>A 52-year-old male with diabetes mellitus presented with large amounts of watery diarrhea, vomiting, dizziness, and palpitations. He managed his diabetes with 70 units of insulin daily and had a history of chronic obstructive pulmonary disease. Physical examination revealed hypotension, tachycardia, and a right-sided apex beat. Investigations, including chest X-ray, ultrasound, and ECG, confirmed dextrocardia with situs inversus and hypovolemic shock secondary to acute gastroenteritis. The patient responded well to treatment and was discharged on the second day, continuing diabetic management.</div></div><div><h3>Discussion</h3><div>SIT is a genetically determined anomaly with an incidence ranging from 1:35 000 to 1:1400, averaging 1:10 000, with a higher prevalence in males. Many patients are asymptomatic, with the condition often detected incidentally. Diagnostic imaging techniques, including chest radiography, CT scans, MRI, and ultrasonography, are crucial in confirming SIT. ECG findings, such as right-axis deviation and reversed QRS complexes, are valuable in diagnosing dextrocardia. Patient education is essential to empower individuals with SIT to navigate their healthcare, prevent complications, and reduce anxiety.</div></div><div><h3>Conclusion</h3><div>SIT poses diagnostic challenges due to its incidental discovery. Accurate diagnosis relies on thorough imaging and clinical evaluation. Patient education is vital for informed care and anxiety reduction. Case reviews underscore the importance of healthcare providers' readiness to diagnose SIT effectively despite unrelated symptoms.</div></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consecuencias de la inadecuada adherencia terapéutica en diabetes mellitus y propuestas de mejora","authors":"Ana María Cebrián-Cuenca ,&nbsp;Rocío Villar-Taibo ,&nbsp;Virginia Bellido ,&nbsp;Pedro José Pinés-Corrales","doi":"10.1016/j.appr.2024.100207","DOIUrl":"10.1016/j.appr.2024.100207","url":null,"abstract":"<div><h3>Introduction</h3><p>The adherence of patients with diabetes mellitus is far from optimal. There are no studies addressing this topic globally.</p></div><div><h3>Aim</h3><p>To provide updated information regarding the extent at which poor adherence influences diabetes mellitus patients' evolution and increases expenditure; to identify causes and propose actions.</p></div><div><h3>Methods</h3><p>Primary care and hospital specialists joined to reach consensus regarding cause identification and specific recommendations.</p></div><div><h3>Results and discussion</h3><p>Poor adherence unacceptably increases morbimortality and expenditure. Causes involve administrations, healthcare providers (HCPs), and patients. Realistic actions are proposed: therapeutic education for patient empowerment; continuous training of HCPs; setting up channels to facilitate fluent communication HCP-patient; improved coordination among care levels; commitment of administrations.</p></div><div><h3>Conclusions</h3><p>Poor therapeutic adherence continues to be a matter of concern. Realistic recommendations are proposed to overcome the problem.</p></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2605073024000178/pdfft?md5=cfac72b11d6f2811339f406699b463b6&pid=1-s2.0-S2605073024000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142076907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental diagnosis of Brugada syndrome in a patient initially presenting with acute coronary syndrome in resource-limited settings: A case report","authors":"Abdirahman Ibrahim Said ,&nbsp;Abdirahman Omer Ali ,&nbsp;Abdiwahab Osman said ,&nbsp;Mouna Ahmed Abdillahi ,&nbsp;Hassan Sh Abdirahman Elmi","doi":"10.1016/j.appr.2024.100208","DOIUrl":"10.1016/j.appr.2024.100208","url":null,"abstract":"<div><h3>Background</h3><p>Brugada syndrome (BrS) is a rare, inherited cardiac disorder characterized by distinctive electrocardiographic (ECG) findings, including right bundle branch block and ST-segment elevations in leads V1–V3. It poses significant risks such as ventricular arrhythmias, syncope, and sudden cardiac arrest, with many cases incidentally detected. Chest pain is present in approximately 17% of cases, presenting diagnostic challenges.</p></div><div><h3>Case presentation</h3><p>This report presents a case of BrS in a patient with ischemic heart disease and discusses the management challenges in resource-limited settings. A 58-year-old Somali man presented with sudden-onset chest pain and associated symptoms. His history included ischemic heart disease and an appendectomy. Examination revealed restlessness and diaphoresis, with normal vital signs. Investigations showed normal troponin levels and an ECG indicating ST elevation in lead V1. Managed with acute coronary syndrome (ACS), he was referred for angiography, revealing mild coronary artery disease and normal ventricular function. Follow-up indicated recurrent headaches and financial constraints limited implantable cardioverter–defibrillator (ICD) placement. BrS is associated with an increased risk of ventricular arrhythmias.</p></div><div><h3>Discussion and conclusion</h3><p>Diagnostic challenges include distinguishing it from ACS due to overlapping ECG patterns. Management options are limited, with ICD insertion and quinidine being primary modalities. Resource limitations, such as the lack of ICD services, complicate management. Ongoing debate surrounds the efficacy and safety of beta-blocker therapy. BrS presents diagnostic and therapeutic challenges, emphasizing the need for comprehensive management approaches. Tailored strategies are essential, particularly in resource-limited settings, necessitating further research to optimize patient outcomes.</p></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S260507302400018X/pdfft?md5=3990a58b6e6db7de6b92c0ba4a83e876&pid=1-s2.0-S260507302400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eficacia de complejo B en la corrección de la deficiencia de vitamina B12 en pacientes mexicanos con diabetes tipo 2 en tratamiento prolongado con metformina: estudio clínico de fase IV","authors":"Leobardo Sauque-Reyna ,&nbsp;Matilde Damián-Hernández ,&nbsp;Melchor Alpizar-Salazar ,&nbsp;Neri A. Alvarez-Villalobos","doi":"10.1016/j.appr.2024.100205","DOIUrl":"10.1016/j.appr.2024.100205","url":null,"abstract":"<div><h3>Background and objective</h3><p>Prolonged use of metformin can cause side effects such as vitamin B12 deficiency. The objective of this study was to evaluate the safety and efficacy of intramuscular B-complex to improve serum vitamin B12 levels in patients with prolonged use of metformin and suboptimal vitamin B12 levels.</p></div><div><h3>Materials and methods</h3><p>This Phase IV study included adults with type 2 diabetes treated with metformin (≥3 years) and serum vitamin B12 levels below 300 pg/ml. The intervention consisted of intramuscular injections of B-complex, with face-to-face and telephone follow-up.</p></div><div><h3>Results</h3><p>Of the 201 patients evaluated, 40 patients at the initial visit had cobalamin deficiency (19.9%), and of these, only 33 (82%) completed the 6-week follow-up. A statistically significant change was observed when comparing baseline vitamin B12 levels with final levels (p &lt; 0.001) in 99.5% of the patients. No significant changes were observed in signs and symptoms of neuropathy, except for leg cramps and general weakness. Anemia symptoms remained unchanged in most patients. No adverse effects were reported.</p></div><div><h3>Conclusions</h3><p>Intramuscular administration of B-complex is safe and effective in increasing serum vitamin B12 levels in patients with type 2 diabetes and prolonged use of metformin. No significant improvements were observed in neuropathy or anemia symptoms. The treatment was well tolerated, and no adverse effects were reported.</p></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2605073024000154/pdfft?md5=294969aec64cc53f4ffa3c2888ecdde4&pid=1-s2.0-S2605073024000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing urachal sinus in older age","authors":"Marta Pinto Dias ,&nbsp;Manuel Ferreira Veloso ,&nbsp;Ana Sofia Novo Oliveira ,&nbsp;João Lemos","doi":"10.1016/j.appr.2024.100206","DOIUrl":"10.1016/j.appr.2024.100206","url":null,"abstract":"<div><p>Urachal sinus (US) is a rare congenital abnormality resulting from the improper involution of embryological tissues connecting the bladder to the umbilicus. It typically presents in childhood but can remain asymptomatic into adulthood.</p><p>A 70-year-old male with hypertension and dyslipidemia presented with periumbilical pain, swelling, and purulent discharge. Initial empirical treatment with antibiotics was ineffective. Further imaging revealed fluid collections consistent with an infected urachal sinus. Surgical drainage and subsequent elective umbilical amputation with herniorrhaphy and hernioplasty resulted in full recovery, with no recurrence of symptoms. This case report highlights the diagnostic challenges posed by its non-specific clinical presentation and emphasizes the need for awareness of urachal anomalies in adults presenting with recurrent omphalitis. Early diagnosis and appropriate surgical management are essential for successful outcomes.</p></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2605073024000166/pdfft?md5=3bc3e5af79a38ad38ae4a8c0c9ce7158&pid=1-s2.0-S2605073024000166-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When seborrheic keratosis is a concern… and melanoma isn't…","authors":"Manuel Ferreira Veloso ,&nbsp;Catarina Alves da Silva","doi":"10.1016/j.appr.2024.100204","DOIUrl":"https://doi.org/10.1016/j.appr.2024.100204","url":null,"abstract":"","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2605073024000142/pdfft?md5=3930f80ea76c20f6a0172ea76da0e87b&pid=1-s2.0-S2605073024000142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Round cell sarcoma in an adult patient from a resource-limited area in Somalia: A case report","authors":"Abdiwahab Osman Saed ,&nbsp;Rahma Mouse Aden ,&nbsp;Sakarie Sh. Dahir Hussein ,&nbsp;Yousuf Ismail Suleiman ,&nbsp;Mohamed Osman Saed ,&nbsp;Hassan Sh. Abdirahman Elmi","doi":"10.1016/j.appr.2024.100203","DOIUrl":"https://doi.org/10.1016/j.appr.2024.100203","url":null,"abstract":"<div><h3>Introduction</h3><p>A tumor refers to an abnormal mass of cells in the body, which can be either benign or malignant. Among cancers, breast cancer is the most frequently diagnosed in females, followed by lung cancer and prostate cancer. Sarcomas, comprising over 70 different subtypes, represent approximately 1% of all cancers.</p></div><div><h3>Case presentation</h3><p>A 21-year-old from Borama, Somaliland/Somalia, presented with a 5-day fever, along with other symptoms. Past surgical history revealed a thyroid lesion diagnosed as round cell sarcoma. Imaging showed thyroid carcinoma with metastases.</p></div><div><h3>Discussion</h3><p>The rising cancer incidence in sub-Saharan Africa is attributed to factors like increased life expectancy and lifestyle changes. Challenges in rare cancer cases include late-stage diagnosis and limited treatment options. Efforts to persuade the patient for treatment are ongoing.</p></div><div><h3>Conclusion</h3><p>Improvements in healthcare infrastructure, access to imaging, and pathology services, along with cultural sensitivity, are crucial in managing rare cancers like round cell sarcoma in sub-Saharan Africa.</p></div>","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2605073024000130/pdfft?md5=993a851c17cb69fc473a2019e0a43e06&pid=1-s2.0-S2605073024000130-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relanzar la atención primaria y comunitaria: un compromiso colectivo","authors":"Amando Martín Zurro ,&nbsp;Joan Gené Badia ,&nbsp;Josep Jiménez Villa ,&nbsp;Carme Batalla Martínez ,&nbsp;Juan José Mascort Roca","doi":"10.1016/j.appr.2024.100202","DOIUrl":"https://doi.org/10.1016/j.appr.2024.100202","url":null,"abstract":"","PeriodicalId":52231,"journal":{"name":"Atencion Primaria Practica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2605073024000129/pdfft?md5=bb2f26c666008aa7792da112fb6ab0fc&pid=1-s2.0-S2605073024000129-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141539790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}