Atencion Primaria Practica最新文献

Breast cancer is the second most common cause of brain metastases (BM) whose clinical manifestations include headache, seizures or paresis. Bleeding due to BM accounts for 2–7% of intracranial haemorrhages. Surgery and radiosurgery are the only local treatments that can improve survival in case of BM haemorrhage.

This is a case of a patient with breast cancer and 4 BM who consulted the emergency department for dysarthria and haemiparesis. Cranial CT scan showed bleeding from her 4 metastases. Surgery was performed with this intention but the patient finally died.

In a patient with a history of neoplastic disease who consults for clinical neurological focality, it is important to rule out the presence of brain metastases, and if such metastases exist, to rule out a complication such as bleeding.

Objective

To compare which skin tag approach tecniques, while adding a new technique, in order to find which produces less complications, less cost and an earlier healing.

Design

Non-blinded randomized clinical trial with consecutive sampling.

Site

Área Básica de Salud Balaguer.

Participants

N = 240 skin tags.

Interventions

The corresponding randomized technique was performed and subsequent follow-up until epithelialization.

Main measurements

Sex, age, family history of skin tags, location of the lesion, diabetes, cost, healing time, complications and technique used. The techniques used were: cryotherapy, electrosurgery, excision with silver nitrate application (SNA) and excision with moist wound healing treatment (MWH).

Results

According to techniques, healing time is lower in MWH (3.3[± 1.0] days) than in dry healing (cryotherapy 4.5[± 2.3] days, electrosurgery 8.2[± 4, 2] days and SNA 10.7 [± 4.8] days), p < 0.001. There was also a significant difference in the number of complications in MWH (0.0%) compared to dry-healing techniques: cryotherapy 1 (3.0%), electrosurgery 4 (11.4%), SNA 22 (57.9%), p < 0.001. Finally, a lower economic cost was observed in skin tags treated with MWH (146[± 9.0] euros) versus those treated with dry cure (cryotherapy 235[± 22.2] euros, electrosurgery 272[± 41.1] euros, SNA 213[± 43.2] euros), p < 0.001.

Conclusions

Treatment of skin tags by MWH is the best technique to treat these lesions because of its shorter healing time, lower cost and fewer complications. SNA stands out as the technique that has the highest number of complications and the longest healing time.

A young female 40 years of age, presented to our Health center complaining of hard nodule in the hard palate for a period of 3 months. She has a sister with a recent Diagnosis of Torus palatinus. With the aim of ruling out a Malignant condition, the patient was referred to Maxillofacial specialist and after assessment a Biopsy of the lesion was taken and described as hyperplasia, papillomatosis and inflammatory cells with abscence of histological malignancy. A CT scan of the head and neck with contrast material was performed shortly after, with the diagnosis of central Torus Palatinus.

Acute or subacute unresolved hearing loss linked to an infectious or inflammatory condition of the middle ear needs early, integrated and multidisciplinary care. Authors stressed the utmost importance of prevention and early management of acute labyrinthitis. The disclosure of this case aims to remind health care providers the existence of this process to avoid sequelae and permanent and disabling damages.

Peripheral neuropathy is a common cause of consultation in primary health care, there are multiple causes, so the etiological diagnosis is a challenge; We describe the case of a 52-year-old female patient with small-fiber peripheral neuropathy initially confused as rheumatoid arthritis. Laboratory tests and biopsy suggested a diagnosis of thyrogastric syndrome as the cause of peripheral neuropathy. Likewise, the evolution of the condition was favorable After treatment.

The purpose of this report is to present an uncommon cause of peripheral neuropathy in order to always take it into account, since it is associated with gastric cancer.

Objective

The COVID-19 pandemic led to a mass use of teleconsultation. The aim of this study is to understand the family doctors' perspective over the utility of teleconsultation in their future clinical practice.

Methods

A cross-sectional study was realized through the application of an online survey, between September 18th and December 4th, 2020. The target population were family medicine physicians and residents who worked in a primary health unit belonging to the portuguese National Healthcare Service. A descriptive analysis of the characteristics of the participants and of their answers to the survey was performed.

Results

377 responses were received. It was identified as the main advantage the greater accessibility (68,7%), as the main disadvantage the impossibility to perform physical examination (81,2%) and as the main obstacle the lack of appropriate resources to teleconsultation (70,0%). The majority of the participants acknowledge that teleconsultation represents a valuable asset to the future of medicine (83,6%). 80,6% of the doctors would like to implement a teleconsultation period in their schedule and 76,1% think that teleconsultation will become essential to future clinical practice.

Conclusion

Published studies support our findings, regarding advantages, disadvantages and obstacles. It is acknowledged that currently neither portuguese population nor family medicine are ready for teleconsultation, although this is considered to be a useful tool to future clinical practice.

Background

The objective of the study was to identify clinical and demographic factors predictive of hospitalization in primary healthcare patients diagnosed with suspected COVID-19 at the beginning of the pandemic.

Methods

A retrospective cohort study design was used. Patients attended in Casanova primary healthcare centre (CAP) (Barcelona, Spain) for symptoms compatible with possible or confirmed SARS-CoV-2 infection between February 24 and May 30, 2020, were included. Data was collected through the electronic medical record and by telephone interview.

Results

518 patients were included, of whom 283 (54.6%) were female. The median age was 50.2 years and 19.3% were aged ≥ 65 years: 79% were followed on an outpatient basis while the rest were hospitalized. Predictive factors for hospital admission were male sex, older age, a history of ischemic heart disease and the presence of dyspnoea, haemoptysis, nausea and vomiting, with a sensitivity of 48% and a specificity of 95.4%. Odynophagia and nasal congestion were predictors of a good prognosis. Mortality was 2.3% and 25% of deaths did not occur in hospital.

Conclusions

Nearly 80% of primary healthcare patients received only outpatient care. Male sex, older age, a history of ischemic heart disease and symptoms like dyspnoea, haemoptysis, nausea and vomiting could lead to a greater risk of an unfavorable evolution during COVID-19. Patients with at least one of the above factors, which correlate with a higher hospital admission rate, should receive a closer follow-up to early detect when they can benefit from a hospital evaluation based on their clinical evolution.

Primary health care crisis is shown in user satisfaction surveys and in the discouragement of professionals. Government, scientific societies, and unions have drawn up numerous documents with proposals to get out of the crisis, but very few have been applied or ended up with a significant change. The crisis is inherent to the primary care discipline because person centered care and population health condition interventions are not aligned with the growing medicalization of a health system focused on health problems care. The proposals are along the following lines: the integration of services in order to deal with the growing increase in chronic pathologies and comorbidity; the transition from control and command leadership to shared leadership; innovations aimed at easing the shortage of family doctors, including increasing other team members and the incorporation of new professions; organizational innovations aimed to improve accessibility, but at the same time increase continuity; the rational use of telemedicine; the modification of the undergraduate curriculum to finally include the discipline of family medicine; and the generalization of successful local community care projects. The future economic crisis, the shortage of professionals and the growing population aging could lead to the gradual application of some of these proposals, since it is not expected that a radical reform will take place.