Articulos American Family Physician

Celiac Disease
R. JOHN PRESUTTI, DO; JOHN R. CANGEMI, MD; HARVEY D. CASSIDY, MD; AND DAVID A. HILL, DO
Patients with persistent gastrointestinal symptoms such as diarrhea, abdominal pain, and bloating should be evaluated for celiac disease. Immunoglobulin A tissue transglutaminase antibody testing is recommended, with confirmatory small bowel biopsy in most patients. Adherence to a gluten-free diet may eliminate symptoms within a few months.
http://www.aafp.org/afp/20071215/1795.html

Patient Information: "Celiac Disease: What You Should Know"
http://www.aafp.org/afp/20071215/1809ph.html


Differential Diagnosis of the Swollen Red Eyelid
ART PAPIER, MD; DAVID J. TUTTLE, MD; AND TARA J. MAHAR, MD
The differential diagnosis of eyelid erythema and edema is broad, ranging from benign, self-limiting dermatoses to malignant tumors and vision-threatening infections. A definitive diagnosis usually can be made on physical examination of the eyelid and a careful evaluation of symptoms and exposures.
http://www.aafp.org/afp/20071215/1815.html


Prevention and Treatment of Sexually Transmitted Diseases: An Update
MICHELE VAN VRANKEN, MD
The Centers for Disease Control and Prevention (CDC) has published revised guidelines for the prevention and treatment of sexually transmitted diseases. Updates include the recommendation to use azithromycin as a first-line treatment of Chlamydia trachomatis infection in pregnant women and no longer recommending quinolones for the management of Neisseria gonorrhoeae infection.
http://www.aafp.org/afp/20071215/1827.html

Patient Information: "Sexually Transmitted Diseases—Prevention and Treatment for You"
http://www.aafp.org/afp/20071215/1833ph.html

Minimizing Adverse Drug Events in Older Patients
CUNG B. PHAM, MD, AND ROBERT L. DICKMAN, MD
Adverse drug events are a common, but often preventable, occurrence in older patients. Use of a multidisciplinary approach and avoidance of prescribing new medications to counteract adverse drug reactions are key.
http://www.aafp.org/afp/20071215/1837.html


December 15, 2007; Vol. 76 No. 12
http://www.aafp.org/afp/20071215/contents.html

Adolescencia, Obesidad y riesgo CV

Adolescent Overweight and Future Adult Coronary Heart Disease
Kirsten Bibbins-Domingo, Ph.D., M.D., Pamela Coxson, Ph.D., Mark J. Pletcher, M.D., M.P.H., James Lightwood, Ph.D., and Lee Goldman, M.D., M.P.H.

Although projections 25 or more years into the future are subject to innumerable uncertainties, extrapolation from current data suggests that adolescent overweight will increase rates of CHD among future young and middle-aged adults, resulting in substantial morbidity and mortality.

NEJM, Volume 357:2371-2379, December 6, 2007. Number 23
http://content.nejm.org/cgi/content/full/357/23/2371?query=TOC

Informacion para pacientes por la Industria Farmaceutica

Información al paciente elaborada por la industria farmacéutica: una amenaza a la salud pública.

THE INTERNATIONAL SOCIETY OF DRUG BULLETINS
Traducción del documento de prensa emitido por la ISDB el 4 de mayo de 2007.
Disponible en:
http://www.isdbweb.org/pag/documents/Publicidaddirigidaalpaciente-ISDB.pdf

La Comisión Europea está apoyando la demanda de la industria farmacéutica para lograr una influencia directa sobre los pacientes. Se espera que en septiembre de 2007 la Comisión introduzca una propuesta legislativa con esta finalidad.
Una muestra de la mala calidad que se espera de esta actividad, es la información al paciente diabético elaborada recientemente por el Pharmaceutical Forum, en el que se encuentra implicada la industria farmacéutica.
La International Society of Drug Bulletins (ISDB) advierte de que la industria no es una fuente de información veraz y fiable y que es un error confundir el hacer publicidad con la información.
Por el contrario, es necesario limitar la influencia de la industria sobre los pacientes así como sobre los prescriptores y, también, mejorar el uso de los medicamentos mediante información fiable, independiente y comparativa para que los pacientes y el público en general puedan tomar decisiones informadas3.
Existen únicamente dos países en el mundo que permiten la publicidad directa al consumidor (PDC) de medicamentos que necesitan receta para ser dispensados: EEUU y Nueva Zelanda. En ambos países, se ha mostrado que la PDC tiene efectos perjudiciales sobre la salud.
Los mensajes de la industria farmacéutica hacen hincapié en unos pocos fármacos, éxitos de ventas, exagerando sus efectos y minimizando sus riesgos, confundiendo así a los pacientes y haciendo presión sobre los médicos para que prescriban medicamentos que de otra manera no utilizarían. La falta de información comparativa hace que el público no pueda elegir entre varias opciones…

Para ampliar la información sobre este tema se recomienda la lectura de:
1. Boletin INFAC 2007, vol 15, nº 6, titulado "Publicidad de medicamentos directa al consumidor: ¿un lobo con piel de cordero?
Disponible en:
http://www.osasun.ejgv.euskadi.net/r52-20738/es/contenidos/informacion/infac/es_1223/adjuntos/infac_v15n6.pdf

2. Serie divulgativa nº 9 de la Sociedad Española de Farmacéuticos de Atención Primaria (SEFAP), titulada : "Publicidad directa al consumidor de medicamentos que requieren receta medica en Nueva Zelanda". Se trata de un informe que contiene un resumen documentado de las pruebas que apoyan la conveniencia de prohibir la Publicidad Directa al Consumidor, además de detallar el estado actual de la opinión de los profesionales y los consumidores neozelandeses.
Disponible en:
http://www.sefap.org/modules.php?name=seriedivulgativa&file=indexficha&filtro=7.

3. Pharmaceutical Forum "Public consultation on Health-related information to patients: the diabetes information package, and the quality principles" (available on http://ec.europa.eu/enterprise/phabiocom/).

4. Joint declaration by HAI Europe, the ISDB, BEUC, the AIM and the Medicines in Europe Forum "Relevant information for empowered citizens" 3 October 2006: 9 pages.
Website: http://www.isdbweb.org accessed 30 April 2007: 8 pages.

5. To learn more about this 'historical background' read the text "BigPharma's health information: a growing danger in Europe" In Joint position of the Medicines in Europe Forum, the International Society of Drug Bulletins, Health Action International Europe "Health information: A clear division of roles is needed to protect public health" March 2007.
Website: http://www.isdbweb.org : 2 pages.

6. ISDB Declaration on therapeutic advance in the use of medicines ; Paris 15-16 November 2001. Website: http://www.isdbweb.org : 12 pages.

Tomado de la Lista de MedFam Argentina.

Fiebre y Erupciones

En el siguiente link de MEDCICLOPEDIA encontrarán una interesante ayuda para abordar casos clínicos referidos al tema, junto a una descripción de estos cuadros dermatológicos tan frecuentes en nuestra práctica diaria.

http://medciclopedia.com/medicina-interna/734/fiebre-y-erupciones/

La ACC y la AHA actualizan sus guías de IAM

El Colegio Americano de Cardiología (American College of Cardiology, ACC) y la Asociación Americana del Corazón (American Heart Association, AHA) han actualizado sus guías de 2004 para el manejo de infarto agudo al miocardio con elevación del segmento ST.
La actualización, publicada en línea en el Journal of the American College of Cardiology, ofrece una lista de las recomendaciones que han sido cambiadas.
Las guías actuales enfatizan añadir clopidogrel a la aspirina y la necesidad de una rápida trombolisis cuando los pacientes no pueden ser sometidos a una intervención percutanea. Los pacientes con IAM con elevación del segmento ST que lleguen a un hospital sin sala de hemodinamia deben ser trombolizados en los primeros 30 minutos a menos que puedan ser trasladados a una sala de hemodinamia y puedan ser sometidos a intervención percutanea en los primeros 90 minutos del contacto médico.

Link para descargar la guía (pdf)en el Journal of the American College of Cardiology
http://content.onlinejacc.org/cgi/reprint/j.jacc.2007.10.001v1

Enfermedad Pulmonar y vuelos aereos

Con control, la enfermedad pulmonar no impide volar

De lo contrario, puede producirse un agravamiento de los síntomas

LANACION.com | Ciencia/Salud | Miércoles 12 de diciembre de 2007

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Hantavirus en Argentina

El primero fue una niña de 14 años, a 40 km de Posadas

Identifican en Misiones nuevos casos de infección por hantavirus

Un equipo de investigadores detectó la especie de roedor que transmite el mal

LANACION.com | Ciencia/Salud | Lunes 10 de diciembre de 2007

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Causas de muerte prematura

Carga de enfermedad: por primera vez calculan cuántos años de expectativa de vida se pierden

Estudian las causas de muerte prematura

Son la enfermedad cardíaca y los accidentes para los hombres, y el infarto cerebral y el cáncer de mama, para las mujeres

LANACION.com | Ciencia/Salud | Domingo 9 de diciembre de 2007

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Top 10 en Temas de Pediatria de 2007

A summary of important new guidelines, recommendations, and research for common pediatric problems
Below are the 10 pediatric summaries that I believe provided new and important insights for pediatric practices. We look forward to collaborating with you in the future.

TOP STORIES

1. New Bronchiolitis Guidelines. Guidelines from the AAP recommend against the use of routine use of chest x-rays, bronchodilators, corticosteroids, and antibiotics for bronchiolitis.
http://pediatrics.jwatch.org/cgi/content/full/2007/110/3

2. New Information About the Genetic Basis for Autism. As we gain understanding of the genetic basis of autism, we hope to improve the treatment and prevention of the disorder.
http://pediatrics.jwatch.org/cgi/content/full/2007/502/4

3. Does Age of Onset Predict Outcomes in Bipolar Disease? Diagnosis of bipolar disease in children often is delayed, resulting in poorer outcomes, but early recognition can lead to better therapeutic results.
http://pediatrics.jwatch.org/cgi/content/full/2007/703/1

4. A Controlled Clinical Trial of Steroids for Bronchiolitis. This excellent study demonstrates that corticosteroids are not effective for treating infants with bronchiolitis. The results support the AAP guidelines mentioned in the first top story.
http://pediatrics.jwatch.org/cgi/content/full/2007/725/1

5. Prophylactic Antibiotic Therapy Does Not Prevent Recurrent UTI in Children. Our common practice of prescribing low doses of antibiotics to children with recurrent urinary tract infection and vesicoureteral reflux is not effective and may even be harmful.
http://pediatrics.jwatch.org/cgi/content/full/2007/808/1

6. Treatment of Gonococcal Infections: No More Fluoroquinolones, Only Cephalosporins. Because of the rising prevalence of fluoroquinolone resistance, cephalosporins must be used as the primary treatment for gonococcal infections.
http://pediatrics.jwatch.org/cgi/content/full/2007/502/2

7. "Heads Up: Brain Injury in Your Practice" Tool Kit. This excellent tool kit is invaluable for pediatricians who manage mild traumatic brain trauma in children.
http://pediatrics.jwatch.org/cgi/content/full/2007/829/4

8. Etiology of Bilateral vs. Unilateral Acute Otitis Media. The finding that bilateral AOM is more likely than unilateral AOM to be bacterial in origin may assist pediatricians in managing this common problem.
http://pediatrics.jwatch.org/cgi/content/full/2007/815/2

9. When Preschool Children Have ADHD. In a randomized, placebo-controlled study of methylphenidate (MPH), preschool children with ADHD benefited from stimulant medications. However, pediatricians must use caution when prescribing MPH because of the high adverse event rate.
http://pediatrics.jwatch.org/cgi/content/full/2007/110/1

10. Overdoing It in Youth Sports. The AAP’s Council on Sports Medicine and Fitness provides recommendations for identifying and counseling children at risk for overuse injuries.
http://pediatrics.jwatch.org/cgi/content/full/2007/725/3

— F. Bruder Stapleton, MD, Editor-in-Chief
Published in Journal Watch Pediatrics and Adolescent Medicine December 5, 2007

Prescribir FKT ("fisiokinesioterapia"), que implica?

The Physical Therapy Prescription

SCOTT E. RAND, MD, Conroe Medical Education Foundation, Conroe, Texas
CHRIS GOERLICH, MSc, PT, Texas Sports Medicine Center, Tomball, Texas
KRISTINA MARCHAND, MD, and NATHANIEL JABLECKI, MD
Conroe Medical Education Foundation, Conroe, Texas.

Numerous guidelines recommend physical therapy for the management of musculoskeletal conditions. However, specific recommendations are lacking concerning which exercises and adjunct modalities to use. Physical therapists use various techniques to reduce pain and improve mobility and flexibility. There is some evidence that specific exercises performed with the instruction of physical therapists improve outcomes in patients with low back pain. For most modalities, evidence of effectiveness is variable and controlled trials are lacking. Multiple modalities may be used to treat one clinical condition; decisions for the treatment of an individual patient depend on the expertise of the therapist, the equipment available, and the desire of the attending physician. A physical therapy prescription should include the diagnosis; type, frequency, and duration of the prescribed therapy; goals of therapy; and safety precautions.
(Am Fam Physician 2007;76:1661-6. Copyright © 2007 American Academy of Family Physicians.)

A PDF version of this document is available (6 pages/152 KB).
http://www.aafp.org/afp/20071201/1661.pdf
The online version of this article includes supplemental content.
http://www.aafp.org/afp/20071201/1661.html

Otitis Media

Diagnosis and Treatment of Otitis Media

KALYANAKRISHNAN RAMAKRISHNAN, MD, FRCSE; RHONDA A. SPARKS, MD;
and WAYNE E. BERRYHILL, MD
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Diagnostic criteria for acute otitis media include rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Fever, otalgia, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common, but nonspecific symptoms. Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis. Observation is an acceptable option in healthy children with mild symptoms. Antibiotics are recommended in all children younger than six months, in those between six months and two years if the diagnosis is certain, and in children with severe infection. High-dosage amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections. Patients who do not respond to treatment should be reassessed. Hearing and language testing is recommended in children with suspected hearing loss or persistent effusion for at least three months, and in those with developmental problems.
(Am Fam Physician 2007;76:1650-8, 1659-60. Copyright © 2007 American Academy of Family Physicians.)

Patient information: A handout on ear infections in children, written by the authors of this article, is provided on page 1659.
A PDF version of this document is available (9 pages/257 KB). Link:http://www.aafp.org/afp/20071201/1650.pdf

GPC Rinosinusitis en adultos

Guidelines for the Diagnosis and Management of Rhinosinusitis in Adults

Guideline source: American Academy of Otolaryngology-Head and Neck Surgery
Literature search described? Yes
Evidence rating system used? Yes
Published source: Otolaryngology-Head and Neck Surgery, September 2007 (supplement)

Each year in the United States, 31 million persons are diagnosed with sinusitis, the fifth most common condition for which antibiotics are prescribed in the United States. Despite the condition's prevalence, the diagnosis and management of rhinosinusitis is highly variable. New guidelines from the American Academy of Otolaryngology-Head and Neck Surgery are aimed at assisting physicians in diagnosing and treating patients 18 years and older with uncomplicated rhinosinusitis (the term rhinosinusitis is preferred because sinusitis is almost always accompanied by inflammation of the contiguous nasal mucosa). Uncomplicated rhinosinusitis is illness without clinically evident inflammation outside the paranasal sinuses and nasal cavity at the time of diagnosis (e.g., no neurologic, ophthalmologic, or soft tissue involvement).
http://www.aafp.org/afp/20071201/practice.html