P. J. Tárraga López

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Objective: to determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain. Methods: a retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Al tiplano Health Area (Murcia) was performed. In our study we con sidered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed di agnoses, which were retrospectively assessed by an external radi ologist who was unaware of the patient’s final diagnosis. Results: our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appen dicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appen dicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphys sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively. Conclusions: a) anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possi ble treatment for acute abdominal pain despite its low diagnostic efficiency.

Impacto económico de la implantación de un programa de cirugía menor en atención primaria

Objetivo.Valorar el impacto economico de la implantacion de un programa de cirugia menor en un area de salud de atencion primaria. Ambito.Atencion primaria. Diseno. Observacional, transversal y retrospectivo. Medidas e intervenciones.Se han registrado todos los pacientes intervenidos de algunas patologias subsidiarias de cirugia menor en los 3 centros de salud del Area de Albacete que participaron en la experiencia piloto desde el 1 de noviembre de 1997 al 30 de octubre de 1998. Se calcularon los gastos fijos correspondientes al personal sanitario y a la amortizacion del area quirurgica diaria. Tambien se calcularon los gastos correspondientes al material fungible y no fungible. Se analizaron los gastos en funcion de la intervencion, y el coste total se comparo con el coste que hubiese supuesto su realizacion en centros especializados privados segun tarifas vigentes de 1998 de companias de seguros. Resultados principales. Durante el periodo de estudio se intervinieron 185 pacientes con una edad media de 64,5 anos (± 21,4) con ligero predominio de mujeres. Las patologias tratadas fueron todas benignas, siendo en 39 casos abscesos, 38 casos de patologia de la una y 35 consistieron en extraccion de cuerpos extranos. Los costes se calcularon sobre la base de tiempo de un ano. El coste total del programa de cirugia menor fue de 1.234.440 pts., mientras que si se hubiese realizado en el nivel especializado hubiese supuesto 2.621.450-4.440.000 pts. Conclusion. En nuestro estudio el programa de cirugia menor en atencion primaria reduce los costes en comparacion con el nivel especializado privado, a la vez que podria mejorar los recursos utilizados en especialidades como cirugia o dermatologia.

Constipation in the population over 50 years of age in Albacete province.

Objective: to determine the incidence of constipation in Albacete province and its relation with diet and lifestyle. Patients and methods: cross-sectional population survey. We studied 414 participants over 50 years of age in Albacete province. 445 persons over 50 years of age were included in the study. All participants were selected by systematic random sampling; 414 participants filled in the questionnaire correctly. Main measures: age, weight and height, marital status, level of education and occupation; presence of a disease, number of sleep hours a day, physical exercise, smoking, alcohol intake, drug intake (anti-inflammatories and laxatives); bowel habit, diet, meal frequency and place; food intake frequency per week, daily intake of water, coffee, tea and herbal beverages; vitamin and fiber supplements; presence of cancer in the family. Results: 56.9% of participants were women. Mean age 67.07 years. In Albacete province, 4.4% of the population over 50 years have a bowel habit consistent with constipation. Most participants had three meals a day (breakfast, lunch, and supper), while 50% had another meal in the morning or afternoon. These meals took place, habitually, in the domicile. There was a preponderance in daily intake of the following foods: milk (83.7%), bread (95.1%), vegetables (68.8%), fruit (91.8%), and virgin olive oil (96.6%). Fish was eaten every one to two days, and pulses and meat every three to six days. 44.4% of participants drank one to two liters of water a day. Only 3.9% of participants took some supplement; 35% of participants were on a diet. It was observed that 97.7% of participants with more than three defecations a week had a high intake of virgin olive oil; 65.7% of participants did some physical exercise customarily; 70.2% of participants were non-smokers, 10.2% were smokers, and 18.4% were ex-smokers. With regard to alcohol, the percentage of drinkers was 35.1%. The main class of medications taken by participants was NSAIDs ‐14.5%; 79.7% took neither NSAIDs nor laxatives. Only 2.7% of participants took laxatives regularly. Conclusions: Most participants had relatively healthy eating habits.

Cirugía menor en un centro de Atención Primaria rural: 2 años de experiencia

Objective: to describe the results derived from performing minor surgery (MS) for the phisician of Primare Health Care (PHM) and analyse the presurgical-pathology diagnosis concordance in a rural Health Center. Design: descriptive prospective study. Participants: interventions performed during two years for two GP. Setting: Primare Health Care Casas Ibanez and Pathology Service of General Hospital Albacete. Measurements and main results: variable descriptives (sex, age, location, lesion diagnosis, motive of MS, sort of intervention, awaiting time and histological results) of all interventions were analysed. It was compared (simple according) previous diagnosis with respect to patholoy diagnosis. Four hundred and twenty-five interventions were performed. Complete data were achieved in 404 persons (229 men, 56,7% and 175 women, 43,7%); mean age of 43,9 years old and standard deviation of 23,9). The most habitual cause for MS was the aesthetic one, continued for malignancy fear and pain. The thecnical of surgery most frequent used were surgical removal in 45, 7% and electrosurgery in 19,2%. Lesions treated mainly were epidermal cyst 43 cases, warts 77 cases and nails 46 cases. Two hundred and twenty cases were sent to Pathology Service and the diagnosis concordance with its report was of 66,2%. The standby time average was of 12 days. Conclusions: performing minor surgery in Primary Health Care is feasible, accepting the proper training of phisician of PC. This activity in our health center has low standby times and high histopathological concordance.

Análisis coste-efectividad de atorvastatina frente a simvastatina como tratamiento hipolipemiante en pacientes hipercolesterolémicos en atención primaria

Objetivo Realizar una evaluacion economica de atorvastatina frente a simvastatina en pacientes hipercolesterolemicos en atencion primaria. Diseno El analisis de coste-efectividad se ha realizado mediante un estudio abierto, prospectivo, aleatorizado, de intervencion en condiciones de uso habitual, en pacientes hipercolesterolemicos (colesterol total [CT] > a 240 mg/dl, cLDL > 160 mg/dl). Pacientes Se incluyo un total de 92 pacientes (44,8% varones), con una edad de 64,9 ± 9,4 anos (media ± desviacion estandar). Un 41,4% era diabetico, el 62,1% hipertenso y un 16,1% fumador. Intervenciones Cuarenta y cuatro pacientes recibieron simvastatina, 20 mg/dia, y 48, atorvastatina, 10 mg/dia, durante 6 meses. Mediciones y resultados principales Los cLDL, CT y trigliceridos se redujeron significativamente con ambos tratamientos. Atorvastatina redujo mas rapidamente los parametros lipidicos (3 meses, p Conclusiones Ambas estatinas se han mostrado igual de efectivas en reducir las cifras de colesterol. Sin embargo, atorvastatina, 10 mg, ha resultado ser mas eficiente que simvastatina, 20 mg, al mostrar una mejor relacion coste-efectividad.

Eficiencia de un programa de cirugía menor en un Centro de Atención Primaria rural

Objetivos . Realizar un analisis coste-efectividad de un programa de cirugia menor en Atencion Primaria. Metodos . Se trata de un estudio descriptivo, prospectivo. Se han analizado las intervenciones de cirugia menor realizadas durante dos anos por 2 medicos de Atenciopn Primaria en el Centro de Salud de Casas Ibanez. Se analizan variables descriptivas (edad y sexo, localizacion, diagnostico lesion, motivo cirugia menor, tipo de intervencion, tiempo de espera y resultados histologicos) de todas las intervenciones. Se compara (acuerdo simple) el diagnostico previo respecto al anatomopatologico. Resultados . Se practicaron 425 intervenciones. Se obtuvieron datos completos en 404 personas (229 hombres y 105 mujeres; edad media 42,36 desviacion tipica 25,03). El motivo mas habitual de cirugia menor fue el estetico, seguido del miedo a malignidad y dolor. Las tecnicas quirurgicas mas frecuentes fueron exeresis quirurgicas 45,7% y electrocirugia 19,2%. Las lesiones tratadas fueron principalmente quiste epidermico 43 casos, verrugas 77 casos y en 46 casos patologia de las unas. Se remitieron al servicio de anatomia patologica 220 casos y el acuerdo diagnostico con su informe fue del 66,2%. El tiempo medio de espera fue de 12 dias. Se realizo un analisis coste-efectividad, resultando que la realizacion de un programa de cirugia menor en Atencion Primaria puede suponer un ahorro de un 49% respecto a los costes en centros especializados concertados con el sistema sanitario. Conclusiones . La realizacion de cirugia menor en Atencion Primaria es factible y su realizacion supone un bajo coste.

Subclinical hypothyroidism and cardiovascular risk factors

OBJECTIVE To determine the prevalence of subclinical hypothyroidism in the general population of an urban health center and describe the clinical characteristics and cardiovascular risk factors in patients with subclinical hypothyroidism. METHODS An observational study, retrospective, reviewing the medical histories of patients sampled from June 2005 until July 2007. We analyzed the following variables; facts: age and sex. Family history thyroid disease and other diseases. Personal History: cardiovascular pulmonary autoimmune, alterations gynecology obstetric diabetes, hypertension (HT) dislipemia, obesity, psychiatric alterations and haematological. Laboratory data: novel TSH, free T4, antiperoxidase antibodies, total cholesterol and its fractions. RESULTS The prevalence of the sample of 100 patients collected over 8 months was 3.8% in the general population over 14 years, of which 79 were women and 21 were men. 13% were type 2 diabetics, 23% had HT and 40% had dyslipidemia. Overweight and obesity were present in 26%. The average level of TSH was 6.92 ± 2.29 μU/ml and the average level of free T4 was 1.16 ± 0.16 ng/ml. CONCLUSIONS Prevalence subclinical hypothyroidism was 3.8%. especially in women with a mean age of 46. The incidence of cardiovascular risk factors in the subjects studied is higher in DM (13%), similar to general population in terms of dyslipidemia (40%) and obesity (23%) and lowest in hypertension (23%). In our study we observed a common pattern in the management of subclinical hypothyroidism, requiring the implementation and promotion of practice guidelines in primary care.

Influencia de un programa de ejercicio físico terapéutico en diferentes indicadores clínicos relacionados con la dislipidemia en sujetos adultos de 26 a 73 años con algún factor de riesgo cardiovascular

INTRODUCTION A sedentary lifestyle is indicated in the international literature as one of the main causes for the onset of some cardiovascular risk factors. OBJECTIVE To assess the effect of a therapeutic physical exercise programme on different clinical indicators related to dyslipidaemia (total cholesterol, HDL and LDL) in sedentary subjects with a cardiovascular risk factor. METHOD Intervention study with before-and-after evaluation of a sample of 340 patients (132 males and 208 females) referred from the 2 primary care centres of the municipality of Molina de Segura (Murcia), and who participated in a 30-week programme of physical exercise combining muscle-conditioning work circuits with other cardio-respiratory resistance workouts. Regarding the clinical indicators, the health professionals collected in the medical history the health indicators corresponding to the biological evolution of the process for which the subjects studied had started the physical exercise programme. RESULTS The statistical analyses showed a significant improvement (p<.005) in the LDL indicator and a non-significant improvement in total and HDL cholesterol indicators after a 3-month exercise programme of 3 weekly sessions. CONCLUSIONS The prescription of physical exercise in dyslipidaemic subjects from primary care centre should be evaluated as a resource for improving the clinical indicators specific to their pathology.