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diseases: thyroid disease in primary care literature

sessions with our colleagues in the care specialist can be very useful especially if we share the same attention to pacientes.Si above are prepared in a didactic, simple and brief we will have taken 45 minutes of the meeting. Alfredo
Yoldi Donostia Hospital Endocrinologist has given us a practical review of thyroid disorders and how to approach them in our department.
The classification disorders where the scan function is useful but does not echo and size disorders (goitre and nodules) where the utility of imaging tests is reversed we found very useful.
has also reviewed the embarazo.Por thyroid problems in the past have discussed the controversial issue of iodine supplementation in pregnancy. Our colleagues in the Group
MBE Murcia society of Family Medicine have published a post on his blog on this tema.Parece that things are not as clear as it may seem to see the treatments that are prescribed in our environment to pregnant.
Interest readings thyroid disease:

-Review Jama subclinical thyroid disorders
Fisterra
-GPC

• hyperthyroidism
• Hypothyroidism Subclinical hypothyroidism
  

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face in the press begins the third edition of the UP. Registration Success!

Today begins the third edition of the Parent University at Bocairent face. Truth is that we are happy for the great response from parents and mothers as the registration centers around 50 people (families). Keep that number at this time is a success and so I would like to thank all parents that you support us both from within and from outside the UP. Thanks to your involvement, interest and enthusiasm, this project makes sense. Sinceramete, thanks. See you in class.

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Sessions (II)

The session is divided into two parts: how to get interesting articles for comment and the presentation of two items.
How to get interesting articles?
tools gives us the 2D web browsing is convenient to major publications with useful our subscription using RSS to magazines, blogs and favorite websites provide us with countless articles for comment.
Google Reader and Netvibes are two tools we can use to manage our subscriptions
echoes many articles of interest to primary care can find discussed in Twiter or distribution lists as medfam .
One of the most powerful constituent services bibliográfica.Estos warning track services and selected journal articles electrónico.Uno sending mail summaries of the most useful is Updat Evidence is which classifies studies utilidad.Otros quality and services can be Amedeo and alert service National electronic Library for Medicine's
Presentation of articles
JF C year, JM Baena Diez, J. Franch, J. Vila, S. Tello, J. Chambers, R. Elosua, and J. Marrugat. Long-term Cardiovascular Risk in type 2 diabetic Compared with nondiabetic first acute myocardial infarction Patients: a population-based cohort study in southern Europe. Diabetes Care.2010 (Sep) 1933:2004-2009. Cohort
This article confirms that even in our population cardiovascular morbidity and mortality in patients with type 2 diabetes is equal to that of patients with AMI but without diabetes.This supposed equivalence between the two populations suggested by Haffner in 1998 had led to the proposal made by different "experts" to move the 2 nd prevention of AMI in diabetic patients.
A systematic review (SR) on 13 recent cohort studies (45,000 patients) comparing these two poblaciones.El risk of MI (fatal or nonfatal) in diabetic patients is 43% lower than patients with IAM.Ninguno was all by studies conducted in our country.
Article object session is a prospective cohort study conducted in Spain on 4,410 patients comparing 2260 patients with type 2 diabetes without prior myocardial infarction of 53 health centers and followed by l group GEDAPS 2150 patients with AMI enrolled in 10 hospitals by the group REGICOR . The risk of MI (fatal or nonfatal) was significantly lower in patients with diabetes HR 0.33 (0.27-0.41) . All cardiovascular events observed, including mortality were lower in the diabetic population (see presentation) even in subgroups with higher risk of diabetes as the most evolved of the disease or Hb A1c levels.
This study further confirms the non-equivalence between the two populations and the need to identify prevention 2 nd in the diabetic population.
Finally ImportNT is important to note the contribution to the generation of self-knowledge and group project REGICOR GEDAPS.

Mason L, Moore RA, Edwards JE, Derry S, McQuay HJ.Topical musculoeskeletal NSAIDs for Chronic pain: Systematic review and meta-analy sis.BMC Musculoskelet Disord.2004; 5:28
To evaluate the RS should consult previous entries on this blog critical reading of this type of study.
The RS studies the role of topical NSAIDs (diclofenac, felbinac, flufenamic, fluribuprofeno, ibuprofen, indomethacin, ketoprofen, piketoprofeno and piroxicam) in chronic musculoskeletal pain.
Patients included are over 40 years with moderate chronic pain including osteoarthritis osteoarthritis but exclude avanzada.Se included 14 trials with 1500 patients. The effectiveness
is evaluated according to the percentage of patients reduced their pain by 50% baseline after 2 weeks of NSAID use and tolerance by the appearance of adverse events and cessation by mismos.La tratamaiento RS has no bias in their design and implementation and quality of RCTs incluyuidos is acceptable (see presentation)




















The proportion of patients in whom 50% decreases the pain is almost Double (RR 1.9, 1.7 to 2.2) in patients with NSAIDs in those assigned to placebo with an NNT 4.6 (3.8 to 5.9) The similar effect all the diseases studied including moderate osteoarthritis (It is interesting to consider the considerable percentage of patients responding to placebo). Tolerance is similar to placebo. A subnálisis
, based on three trials (764 patients), which compares oral and topical NSAIDs in osteoarthritis (knee / hand) with no differences between the two.
Although the tolerance in this review was similar to placebo this year Afssaps French withdrew Ketoprofen gel because fotosensibilización.Este problems has been made to review the safety of this drug to the European agency he has not retired but has qualified the precautions for use and has banned its dispensing without prescription.
is worth remembering that clinical trials often are not able to detect adverse effects due to limited periods studies and the small number of patients included.
used topical NSAIDs perídos two weeks is a reasonable alternative tratmiento especially useful in patients intolerant to oral polypharmacy

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The cavitation or liposuction without surgery has become a revolution by removing the fat and centimeters want without going under the knife. Laser Natura Chueca supply leads cavitation in Madrid with the latest equipment technology.

cavitation circuit performed with an approximate duration 90 minutes is based on the strategic combination of 4 treatments: cavitation, electroporation, acupressure and vibrating platform seeking to achieve 3 goals: reduction inches, reduce cellulite and firm the skin .

Treatments

1) The cavitation called liposuction without surgery, as no pain and no the major drawbacks of liposuction surgery, destroys fat. It is based on the application of ultrasound through a head in contact with the skin at 40 kHz to create micro bubbles in the fat layer to break down fat cells and fat free to stream node.

teams are key to the results of this treatment and why we have the best on the market considered it Sorisa Impact ( http://www.sorisa.com/inici.htm ) . The safety and effectiveness are very important in cavitation and Impact are the only team that has been calibrated to ensure 39-40 Khz, thanks to the design of a caliper designed by approved own department of R & D Sorisa, when cavitation occurs real and safe. The other teams in the market operate by frequency sweeps can not guarantee the 40 Khz.

Impact also has intelligent heads for the patented technology that besides making Smartcav electroporation while cavitation, are the only ones reported in the state all the time ensuring maximum treatment efficiency and intensity and identify if the computer is docked or not, emitting only when in contact with skin, making it not deduct treatment time and the 40 minutes we do sean en tiempo real de contacto con la piel y por tanto de cavitación.

A través de este mismo cabezal y de forma simultánea se realiza la técnica de la electroporación.

2) Electroporación. A través de corrientes eléctricas creadas por campos magnéticos se abren los poros de la zona donde actúa el cabezal y penetra el cosmético con propiedades reductoras, o anti celulíticas y reafirmantes que vamos aplicando, potenciando los efectos reductores de la cavitación y teniendo un efecto reafirmante.

cavitation treatment and electroporation is the most common 40-minute real-time cavitation to be effective by 10 minutes each about 200-250 cm2. It takes between 5 and 10 sessions are usually for solid results.

3) Presoterapia . After a session of cavitation takes place a meeting of drainage to facilitate the removal of fat cells destroyed by a team of next generation acupressure ( Impress 240, Sorisa) lasting 25-30 minutes. Pressure therapy is done with a tourniquet is placed ranging from feet to abdomen, which are air blown through 6 valves controlled form of distal to proximal.

This pressure causes them to stimulate blood and lymphatic system resulting in multiple benefits: elimination of liquids for people with memory problems, prevention and treatment of varicose veins, cellulite reduction (accumulation of fat in a flow area with circulatory problems) to improve blood circulation in the affected area, and finally lymphatic drainage which speeds the elimination of fat from of adipocytes during cavitation.

4) Finally, we recommend the use of Vibrating Platform for 10 minutes equals 60 minutes of gym, ending the session. The platform helps activate the metabolism, making exercises reinforce key areas targeted in the treated area and weight loss among other benefits.

Bonus Circuit cavitation and electroporation of 40 minutes, acupressure and a platform for 5 sessions out of 475 euros and 850 euros for 10 sessions and offer credit facilities. Also fertilize up to 2 hour parking in the parking lot of the Plaza Vázquez de Mella and Augusto Figueroa

The number of sessions we recommend following a free diagnostic scan prior to treatment, which also provide more detailed information if desired .

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journal club-( I) Session

Within clinical sessions that may be performed at a health are bibliográficas.Básicamente sessions consist of articles recently published comment. Often a service hospital or health center are dealt specialized magazines among staff members (including residents) and each comment on the articles that have caught your attention.

raised in the meeting for next Thursday, 7 October discuss how we can do this much better with the tools that provides web 2.0 and discuss two articles on the cardiovascular and diabetes risk and the use of topical NSAIDs in base two recent publications. As always we have prepared a preliminary survey to help us make the session more useful.