Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud

ObjetivoPrincipal: valorar la modificación del riesgo coronario (RC) en pacientes adultos tras 8 años de su incorporación al Programa Actividades Preventivas y Promoción Salud (PAPPS). Secundario: determinar nivel de vacunación antitetánica alcanzado y cumplimiento de actividades.DiseñoEstudio de intervención sin asignación aleatoria «antes-después».EmplazamientoUna consulta de medicina general de un centro de salud.PacientesUn total de 429 pacientes (204 varones, 225 mujeres) de 30-65 años seguidos durante 8 años, captados por búsqueda activa de casos en la consulta diaria.IntervencionesDeterminación de tensión arterial, colesterol, peso, tabaquismo, ingesta etílica, estado vacunal antitetánico, cálculo del RC a los 10 años según Framinghan y grado de cumplimiento de actividades. Estas variables se determinaron al inicio, a los 4 y a los 8 años. Datos obtenidos de la historia clínica.ResultadosPoblación total: a los 8 años descenso del RC, 0,8 (IC diferencia, 0,4-1,2), equivalente al 8,5% del inicial. Incremento obtenido de la vacunación antitetánica correcta del 64,4% (IC diferencia, 59,9-69%). Cumplimiento actividades al inicio y al octavo año: tensión, 100%, 71%; consumo tabaco, 99,5%, 71%; determinación colesterol, 89%, 64%. Subgrupo RC inicial alto: a los 8 años descenso del RC, 6,7 (IC diferencia, 4,9-8,5), equivalente al 24,8% del inicial.ConclusionesEn la población total el descenso del RC obtenido no es clínicamente significativo, mientras que en el subgrupo con RC inicial alto el descenso sí lo ha sido. Probablemente debería hacerse búsqueda activa de los pacientes con RC alto y actuar sobre ellos.ObjectivesMain: to assess the change in coronary risk (CR) in adults after 8 years of their involvement in the Programme of Preventive Activities and Health Promotion (PAPPS). Secondary: to determine the level of anti-tetanus vaccination reached and patients' compliance with activities.Design«Before and after» intervention study without random allocation.SettingA general medical clinic at a health centre.Patients429 patients (204 men, 225 women) between 30 and 65 monitored for 8 years, recruited by active search for cases at daily consultations.InterventionsBlood pressure, cholesterol, weight, tobacco habit, alcohol intake, anti-tetanus vaccination state, CR calculation at 10 years on the Framingham scale, and degree of compliance with activities were all determined at the start, at 4 years and at 8 years. Data was obtained from the clinical notes.ResultsTotal population: a 0.8 drop in CR (CI difference: 0.4-1.2), equivalent to 8.5% of the initial figure. 64.4% increase in correct anti-tetanus vaccination (CI difference: 59.9-69). Compliance with activities at the start and after eight years: pressure 100%, 71%; tobacco consumption 99.5%, 71%; cholesterol determination 89%, 64%. Initially high CR sub-group: 6.7 drop of CR at 8 years (CI difference: 4.9-8.5), equivalent to 24.8% of the initial figure.ConclusionsIn the total population, the CR drop found was not clinically significant, whereas in the initially high CR sub-group the drop was. There should probably be an active search made for patients with high CR and action taken on them

Dirofilariose pulmonar humana, adquirida no Brasil: comunicação de um caso Case report: human pulmonary dirofilariasis acquired in Brazil

É comunicado caso de dirofilariose humana, adquirida no Brasil. Trata-se do segundo acometimento dessa natureza publicado em literatura científica. Como expressão clínica, foram evidenciados dois nódulos pulmonares, através de exame radiológico convencional e de tomografia computadorizada. O diagnóstico decorreu de análise histopatológica de uma das lesões.<br>We report the second published case of human dirofilariasis acquired in Brazil. The patient had two pulmonary coin lesions seen in conventional chest roentgenogram and confirmed as solid round nodules by computherized X-ray chest scan. Diagnosis was done by surgical removal of one of the lesions and anatomopathological study of tissue removed

Human pulmonary dirofilariasis: a review

The authors presented a detailed summary of the geographical distribution, clinical and pathological aspects of human pulmonary dirofilariasis. Although benign, this zoonosis, of which Dirofilaria immitis is the major etiological agent, represents a medical problem since it produces symptoms which may be confused with neoplasia and thus may subject patients to unnecessary thoracic surgery. Of 229 cases cited in the literature, only 17 were reported in Brazil, despite the existence of highly favorable conditions for the transmission of this infection in man. Thus it may well be that this parasitic infection remains underdiagnosed. Finally, the importance of a differential diagnosis between dirofilariasis and pulmonary neoplasia is emphasized in cases where there is a solitary subpleural nodule ("coin lesion") present. In addition, the development and improvement of modern immunological diagnostic techniques are essential to distinguish this benign disease from other pathological conditions and thus avoid unneccessary surgery. These techniques may reveal the true prevalence of this parasitic infection in our environment