Atencion Primaria Practica最新文献

Objective

Design

Setting

Participants

Main measurements

Results

Conclusion

Introduction

Case presentation

Discussion

Conclusion

Introduction

The adherence of patients with diabetes mellitus is far from optimal. There are no studies addressing this topic globally.

Aim

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.

Methods

Primary care and hospital specialists joined to reach consensus regarding cause identification and specific recommendations.

Results and discussion

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.

Conclusions

Poor therapeutic adherence continues to be a matter of concern. Realistic recommendations are proposed to overcome the problem.

Background

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.

Case presentation

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.

Discussion and conclusion

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.

Background and objective

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.

Materials and methods

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.

Results

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 < 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.

Conclusions

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.

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.

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.

Introduction

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.

Case presentation

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.

Discussion

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.

Conclusion

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.