Journal of General Practice

Roman physician Claudius Galen recognized two types of disabling mental illness, madness and melancholia. He believed these disorders were caused by humoral imbalance and often prescribed bleeding as a method of relieving the most severe symptoms. Many other methods of symptom control have been tried and the names have changed and multiplied, but the causes are no better known today than they were to Galen. 'Madness' (now several kinds of schizophrenia) is filed under international code #295 and 'mania' (an even greater number of named mood disorders) under #296. ‘What’s in a name? That which we call a rose by any other name would smell as sweet.’ Wm. Shakespeare. Romeo and Juliet (II, ii, 1-2)

Symptom relief is a commendable goal but no proof that a drug corrects anything. Aspirin can often relieve fever and pain, but it does not treat the causes. Medicines prescribed to treat organic diseases — such insulin for diabetes and digitalis for heart failure — have measurable effects that can and must be monitored.

Hundreds of syndromes in the Diagnostic and Statistical Manual only confuse any search for cure, but they give symptoms the appearance of ‘recognized medical disorders’. That allows the pharmaceutical industry to advertise psychoactive drugs — analgesics, stimulants, and sedatives — as if they were medicine. Psychoactive drugs are notoriously addictive, which tends to build life-time customers. That is unfortunate for the wide use of drugs, especially stimulants, may contribute to violence.

Malignant bowel obstruction is a frequent complication in patients with advanced cancer. Based on a case presentation this article will highlight a palliative medicine approach to addressing this distressing complaint. Focusing primarily on the prevailing treatment options of malignant bowel obstruction at the end of life, this article also evaluates decision making process behind the care of malignant bowel obstruction and highlights a patientcentered care.

The conceptual elements and skills that promote the mastery of family medicine, such as contextual knowledge, continuity of care, the clinical interview, comprehensiveness, coordination, and so on, are often difficult to explain and to understand. Medicine is often learned through a mechanistic metaphor of biology and a military metaphor of war. However, these fundamental concepts of family medicine have nothing to do with the metaphor of the machine or the metaphor of war. In this book, “THE FAMILY DOCTORS: Images and Metaphors of the Family Doctor to Learn Family Medicine”, these concepts are explained through metaphors that are more explanatory, nicer, sweeter, and more playful. Thus, among other metaphors, the family doctor is presented as the genie in Aladdin’s lamp, as a drinker of Chinese tea, a classic painter, an explorer on a desert island, as a bass, a plug, a photographer, an historian, a person eating spaghetti or cherries, a cat, a civil engineer, a catalyst, a meteorologist, a detective, a fisherman rather than a hunter, a sculptor, a sea turtle, a golfer, a filter coffee, a diver, a poet, a billiards player, a mother who picks up her baby, and a nuts and bolts mechanism. Thinking based on metaphors and comparisons is a way of making a concept so suggestive, interesting and surprising, that it reaches people more easily. The value of family medicine lies in its distinctiveness from academic medicine. Thus, the family doctor should be encouraged to use a non-conventional form when thinking about the problems that are presented in the consultation, for example, thinking on the basis of metaphors.

Objective: To compare the efficacy and safety of 10 mg amlodipine, 12.5 mg captopril and combination of 5 mg amlodipine and 6.25 mg captopril in patients with hypertensive urgency at emergency room. Study design: This was a single-center, randomized, double-blinded clinical trial in hypertensive urgency patients (systolic blood pressure (SBP) ≥ 180 mmHg and/or diastolic blood pressure (DBP) ≥ 110 mmHg). The patients were randomized to receive 10 mg amlodipine (group A), 12.5 mg captopril (group B) or combination of 5 mg amlodipine and 6.25 mg captopril (group C). Blood pressure was measured every 30 minutes during 4 hours after administration. The therapeutic response was defined as 15% to 25% reduction in mean arterial blood pressure (MAP). Results: Eighty-two patients were recruited (23, 28 and 31 patients in group A, B, and C, respectively). All three regimens achieved the blood pressure target around half of the patients (52.2%, 53.5% and 51.6% in group A, B and C, respectively), but there was no statistical difference among three groups. There were only minor adverse events reported, i.e., headache, dizziness and fatigue, which were similar in all groups. Conclusion: The efficacy of 10 mg amlodipine, 12.5 mg captopril and combination of 5 mg amlodipine with 6.25 mg captopril in treating patients with hypertensive urgency to achieve target blood pressure was comparable. No major adverse events were observed and minor adverse events were minimal among three groups. This finding suggested that three regimens could be safely used in emergency room for treating hypertensive urgency

It is a common observation that pain and stiffness in patients known to have arthritis get worse in cold and damp weather conditions. The objective of this article is to review the available literature on this subject and to put forward an explanation for this common clinical finding. Literature search revealed twelve relevant articles including laboratory experiments and prospective questionnaire-based human studies. Various investigators have tried to study the effect of cold weather on arthritic symptoms and have suggested different theories. The effect of temperature changes localized to the joints has shown to increase stiffness at lower temperatures and decrease stiffness at higher temperatures. The effect of these changes has been found more pronounced in elderly population with arthritis and patients with advanced disease. The evidence to support this common observation is weak; however some studies have reported a trend towards worsening of pain and stiffness with falling temperature and barometric pressure in arthritic patients.

Currently, the criterion used to diagnose the condition of PCOS is the same in women of all reproductive age group, which should not be the case. As teenage symptoms like irregular periods, acne and appearance of polycystic ovaries are commonly present in all adolescent girls after puberty, it is difficult to make an accurate diagnosis. Hence it will be better to wait for few years rather than making a hasty diagnosis of the teenage girls. The presence of metabolic syndrome should be targeted in the screening of these girls, who are suspected to have PCOS.

From a previous publication by the authors about an imported case of Chikungunya (a disease little known in Spain, but with numbers increasing worldwide, and due to the presence of the vector in the Mediterranean area), we show a fable to explain in brief, a deepening on epidemiological implications in family medicine, which is not made in standard textbooks and can be a contribution relevant to the practice of family medicine in their interconnection with epidemiology. The story or metaphor exposed allows induce conceptual categories of how it should look epidemiology, both in infectious diseases and chronic diseases, from family medicine, showing differences, nuances, approaches and practical tools of epidemiological work, which could be applied to any case or patient, and which are different between family medicine and other medical specialties, such as: 1. the great accessibility of patients to their family doctor, and its role as first contact with the patient ("numerator"); 2.- the continuity of care that allows knowledge of incidence and prevalence rates; 3.- The special method for screening ( "case-finding"); 4.- differences between sensitivity and specificity of diagnostic tests regarding the hospital setting; 5.- the work with a population as "denominator"; 6.-the conflict between the recommendations of experts in public health and clinical practice with the particular patient (differentiation between frequentist or Bayesian probability); and 7.- the work with small geographic bases.

Background: The appendiceal diverticulum is an uncommon pathology. Its most common clinical presentation is the appendiceal diverticulitis and the symptoms are similar to acute appendicitis. Also, it can be considered as part of differential diagnosis for chronic abdominal pain.
Aim: Analyze the prevalence in our hospital of appendiceal diverticulosis in acute appendicitis and literature review.
Methods: Retrospective description study (January 2004 to December 2013) looking for presence of appendix diverticula in 1526 patients after appendectomy due to suspicion of acute appendicitis. Review of literature for term results: “appendiceal”, “appendicular”, “diverticulitis”, “diverticulosis”.
Results: Total sample: 2058 patients operated of appendectomy; 1526 of those were to suspicion of acute appendicitis and in 38 of those we found presence of appendiceal diverticula (2.49% prevalence). Distribution: men/ women (68.42%/31.57%), middle age (46.71 years). Lipton classification: Type I (28.94%), type II (34.21%), type III (21.05%) and type IV (15.78%). Other associations: carcinoid tumor (2.36%), villous adenoma (2.63%), serrated adenoma with low grade dysplasia (2.63%), perforated diverticula (7.89%), chronic diverticulitis (5.26%).
Conclusion: Prevalence is slightly higher in our series, probably because we considered only patients with acute appendicitis and not all surgical specimens with cecal appendix. According to reviewed bibliography there is possible relation with appendix neoplasias, more risk of perforation and mortality. It is a difficult pre-operative diagnosis and it has to be considered in the differential diagnosis for (acute and chronic) abdominal pain in right iliac fossa.