Journal of General Practice

Objective: To quantify and characterize the initiation of Potentially Inappropriate Prescription (PIP) of statins in primary prevention of Cardiovascular Disease (CVD) in patients with low cardiovascular risk in the Basque Health Service (Osakidetza) by estimating the annual incidence rate and identifying the associated clinical and socio-demographic factors.

Methods: Analytical retrospective observational study on the incidence of PIP of statins and provision of advice for changing lifestyles in 2018. Patients aged 40 to 75 years with cardiovascular risk <5% (REGICOR) and LDL-cholesterol levels between 70 and 189 mg/dl and/or Total Cholesterol (TC) between 200 and 289 mg/dl. Sociodemographic and clinical characteristics and deprivation index were evaluated. Global incidence, factors associated with PIP and the variability between Integrated Health Organizations (IHOs) were analyzed.

Results: 70,526 people met the selection criteria. Of them, 741 started a PIP for statins with an overall incidence of 10.5 prescriptions per 1,000 person-years (ranging in IHOs from 2.3 to 18.0). Less than 40% of these people received preventive advice on physical activity and diet and approximately 50% received advice on cessation of smoking. PIPs were higher in men (RR 1.36), people with arterial hypertension (RR 1.86) and other comorbidities (RR 3.93 if ≥ 5 comorbidities); PIPs also increased with age (RR 1.02 per year) and TC levels (RR 1.21 per 10mg/of the increase).

Conclusion: This study shows that practice in primary CVD prevention in low-risk primary care patients does not seem to follow the recommendations of current guidelines. It is necessary to identify determinants associated with this low-value practice in order to inform the design and implementation of strategies to favor its abandonment.

Objective: Case report of chronic migraine with comorbid sleep apnea that regressed to low-frequency migraine after tonsillectomy

Background: According to the International Classification of Headache Disorders III (ICHD-3), sleep apnea can be a cause of headache or a trigger for the chronification of migraine. Large tonsils that obstruct airways contribute to tonsillolith formation, halitosis, periodic tonsillitis and occasionally cause sleep apnea. Adequate treatment of sleep apnea can result in the improvement of migraine frequency and intensity, and reduce the risk of cardiovascular and cerebrovascular comorbidities.

Results: The patient‏‎ is a 24 years old woman with a past medical history of obesity and asthma, with a chief complaint of ICHD-3 chronic migraine without aura. She experienced a frequency of 15-20 headache days per month, frequently with morning headaches and 3-5 sleep interruptions per night. She noted a history of snoring, feeling poorly rested and having daytime drowsiness. After tonsillectomy, the patient experienced significant improvement of her migraines and her sleep apnea associated symptoms, including spontaneous arousals, feeling poorly rested and daytime drowsiness.

Conclusions: In patients complaining of chronic migraine and sleep dysfunction, visualizing the posterior pharynx should be incorporated into the physical examination. Tonsillectomy is a well-tolerated, same day surgical procedure, which can be an effective treatment for reducing airway resistance in patients diagnosed obstructive sleep apnea, and can improve the frequency and intensity of co-morbid migraine.

The infant young child feeding model of World Health Organization (WHO) suggests introducing complementary food for new born babies starting at the sixth month. Breast milk has to be round out by any other foods to fill the nutrient demand of the child. These complementary foods are required to fill the calorie, protein and micronutrient gap between the total nutritional need of the child and the amount contributed by the breast milk. Sufficient complementary food has to be diversified and prepared from different food groups in a solid or semisolid form and needs to be commenced timely from the sixth month of the child’s age by implementing the quality of foods consumed as the child get older.