Growth in height and body proportion from birth to adulthood in hereditary hypophosphatemic rickets: a retrospective cohort study.

PURPOSE: Patients with hereditary hypophosphatemic rickets are short and disproportionate and very little information is available on segmental growth, but the body disproportion at adulthood leads us to think that the growth velocity of legs is slower. METHODS: A total of 96 children were included and molecular testing was carried out in 42. Children who reached adult height were classified into two groups according to their compliance to conventional treatment (phosphate supplement and calcitriol). Individual growth records of height and sitting height/height were plotted using Argentine reference data in 96 children and growth curves were estimated by fitting Preece-Baines Model 1 in 19 of the children. RESULTS: Molecular testing revealed sequence deleterious alterations or large deletions in 36/42 patients. During childhood, 76% of children grew below - 1.88 standard deviation score (SDS) and 97% had body disproportion. During adolescence, the mean peak height velocity for the good and poor compliance to treatment groups was 7.8 (0.6) and 5.4 (0.4) cm/year in boys and 7.0 (0.7) and 5.2 (0.8) cm/year in girls, respectively. At adulthood, the median sitting height/height ratio was 2.32 and 6.21 SDS for the good and poor compliance to treatment groups, respectively. The mean pubertal growth spurt of the trunk was -0.8 (1.4) SDS, with a short pubertal growth spurt of - 1.8 (0.4) SDS for limbs in the good compliance group. Median adult height in 13/29 males and 30/67 females was -4.56 and -3.16 SDS, respectively. CONCLUSION: For all patients the growth spurt was slower, secondary to a short growth spurt of limbs, reaching a short adult height with body disproportion that was more prominent in the poor compliance group.

[Causes of hospital admission and morbidity according to gender identity in the Autonomous Community of Madrid].

The objective was to identify differences in health between transgender (trans) and cisgender (cis) people using the hospital discharge survey from the Autonomous Community of Madrid. Their characteristics, causes of admission and morbidities were described, comparing them by prevalence ratio and confidence interval (95% CI). One hundred and twelve trans vs 1,043,621 cis discharges were studied. The main differences were that more frequently trans people had been attended in a single center (55.4 vs. 9.3%), were under 49 years old (75.9 vs. 37.1%) and had used private health services (2.7 vs. 0.4%). Admissions related to mental health problems (23.96; 95% CI: 17.41-32.78) and HIV morbidity (11.26 95% CI: 5.46-20.93) were more frequent among trans discharges. Information is limited beyond body modification, mental health, and HIV. It is necessary to improve the knowledge about trans population's health.

[Tumores neuroendocrinos pancreáticos. Nuestra experiencia]. / Pancreatic neuroendocrine tumors. Our experience.

Pancreatic neuroendocrine tumors are rare. It is a heterogeneous group of neoplasms with very different behavior and prognosis. They can appear sporadically or associated with genetic syndromes. They are divided into functioning and non-functioning. A descriptive retrospective study of patients diagnosed with pancreatic neuroendocrine tumor was performed. The incidental diagnosis of these tumors is increasingly. The only curative treatment for these tumors is surgical excision, depending on the location and characteristics of the tumor and the patient. In selected cases a conservative attitude is recommended.

Los tumores neuroendocrinos pancreáticos son poco frecuentes. Es un grupo heterogéneo de neoplasias con comportamiento y pronóstico muy diferentes. Pueden aparecer de manera esporádica o asociados a síndromes genéticos. Se dividen en funcionantes y no funcionantes. Se realizó un estudio retrospectivo descriptivo de los pacientes diagnosticados de tumor neuroendocrino pancreático. Como se refleja en nuestra serie, cada vez es más frecuente el diagnostico incidental de estos tumores. El único tratamiento curativo de estos tumores es la exéresis quirúrgica, según la localización y las características del tumor y del paciente. En casos seleccionados se puede optar por una actitud conservadora.

Evaluation of bacterial adherence of clinical isolates of Staphylococcus sp. using a competitive model: An in vitro approach to the "race for the surface" theory.

OBJECTIVES: Implant-related infection is one of the most devastating complications in orthopaedic surgery. Many surface and/or material modifications have been developed in order to minimise this problem; however, most of the in vitro studies did not evaluate bacterial adhesion in the presence of eukaryotic cells, as stated by the 'race for the surface' theory. Moreover, the adherence of numerous clinical strains with different initial concentrations has not been studied. METHODS: We describe a method for the study of bacterial adherence in the presence of preosteoblastic cells. For this purpose we mixed different concentrations of bacterial cells from collection and clinical strains of staphylococci isolated from implant-related infections with preosteoblastic cells, and analysed the minimal concentration of bacteria able to colonise the surface of the material with image analysis. RESULTS: Our results show that clinical strains adhere to the material surface at lower concentrations than collection strains. A destructive effect of bacteria on preosteoblastic cells was also detected, especially with higher concentrations of bacteria. CONCLUSIONS: The method described herein can be used to evaluate the effect of surface modifications on bacterial adherence more accurately than conventional monoculture studies. Clinical strains behave differently than collection strains with respect to bacterial adherence.Cite this article: M. Martinez-Perez, C. Perez-Jorge, D. Lozano, S. Portal-Nuñez, R. Perez-Tanoira, A. Conde, M. A. Arenas, J. M. Hernandez-Lopez, J. J. de Damborenea, E. Gomez-Barrena, P. Esbrit, J. Esteban. Evaluation of bacterial adherence of clinical isolates of Staphylococcus sp. using a competitive model: An in vitro approach to the "race for the surface" theory. Bone Joint Res 2017;6:315-322. DOI: 10.1302/2046-3758.65.BJR-2016-0226.R2.

Referencias argentinas de estatura sentada y longitud de miembros inferiores de 0 a 18 años / Argentine reference values for sitting height and lower limb length between 0 and 18 years of age

Para el seguimiento del crecimiento de niños con severa malformación de miembros inferiores o de columna, disponer de referencias de estatura sentada (ES) y de miembros inferiores (MI) según edad es una herramienta de gran utilidad. Objetivos: estimar los centilos de ES y MI para ambos sexos, entre 0 a 18 años de edad y evaluar la utilidad de estas referencias en niños con malformaciones localizadas en MI o columna. Material y Métodos: los centilos 3°,10°, 25°, 50°, 75°, 90° y 97° de ES y MI según Edad (SE/E y MI/E) fueron estimados en una población sana de 4803 y 4818 varones y mujeres respectivamente, por el método LMS que utiliza la transformación BOX-COX para normalizar la distribución de los datos a cada edad. Resultados: en los primeros años de edad, la mediana de ES en ambos sexos fue similar. Entre los 11 y 13 años, las niñas tuvieron una ES mayor a la de los varones, pero luego se invirtió y se mantuvo así hasta la adultez. En MI la mediana también fue similar en ambos sexos durante los primeros años, pero a partir de los 12 el incremento fue mayor en los varones. A los 12 años la diferencia fue 0,71 cm, finalizando con 9 cm a los 18 años. El uso de estas referencias en niños con malformaciones de columna ó MI mostró un crecimiento patológico de estatura total y del segmento corporal comprometido, con un tamaño y crecimiento normal del segmento no afectado. Conclusión: los centilos de segmentos corporales según la edad constituyen una herramienta útil para la supervisión del crecimiento de niños con severa malformación de columna o miembros inferiores (AU)

For the follow-up of growth of children with severe lower-limb or spinal deformities, reference values for sitting height (SH) and lower-limb (LL) length according to age are extremely useful. Aims: To define percentiles of SH and LL for both sexes between 0 and 18 years of age and evaluate the usefulness of these references in children with LL or spinal deformities. Material and Methods: 3rd,10th, 25th, 50th, 75th, 90th, and 97th percentiles for SH and LL according to age (SE/age and LL/age) were estimated for a healthy population of 4803 and 4818 boys and girls, respectively, with the LMS method that uses the Box-Cox power exponential (BCPE) to normalize data distribution for age. Results: In the first years of life, mean SH was similar for both sexes. Between 11 and 13 years of age, girls had a greater SH than boys, but this relationship subsequently inverted and remained so until adulthood. The median length of LL was also similar in the first years of life, but after 12 years of age growth was increased in boys. At 12 years of age the difference was 0.71 cm, with a final difference of 9 cm at 18 years of age. The use of these reference values in children with spinal or LL deformities showed pathological growth of the whole body and the body segment involved with normal growth of the nonaffected segment. Conclusion: percentiles of the body segments according to age are a useful tool for the monitoring of growth of children with severe deformities of the spine or lower limbs (AU)

Usefulness of cardiac resynchronisation therapy devices and implantable cardioverter defibrillators in the treatment of heart failure due to severe systolic dysfunction: systematic review of clinical trials and network meta-analysis.

AIM: To assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. METHODS: A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. RESULTS: 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT+ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. CONCLUSIONS: The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options.

Use of anodized titanium alloy as drug carrier: Ibuprofen as model of drug releasing.

The use of osteoarticular implants has improved the quality of life of millions of patients. In this work nanotubular structures tailored made on Ti6Al4V substrates was used as drug delivery system of ibuprofen as a proof of concept. Three different nanotubular films with different sizes and forms (NT, NT+ and NTb) were analysed. Samples were soaked in a solution of 660 mg ibuprofen/20 mL n-pentane. The ibuprofen release in aqueous medium was evaluated by liquid chromatography reversed-phase (RP-HPLC). To calculate the observed constant k, the amount of ibuprofen released was plotted versus the time using linear regression according to the zero-order, first-order, second-order and Higuchi model. The release of ibuprofen was constant and independent of the concentration. The kinetic constant obtained was 0.021 (NT), 0.022 (NT+) and 0.013 (NTb) being the correlation factor of 0.98 (zero-order) where the maximum correlation factor was reached. These results indicate that the delivery process from NT and NT+ is similar and slower that NTb. In all the cases was inside the therapeutically range. These results showed the potential of these modifications in order to develop implants that can carry different molecules of medical importance.

Atmospheric corrosion of brass in outdoor applications: patina evolution, metal release and aesthetic appearance at urban exposure conditions.

Short (days, weeks) and long-term (months, years) non-sheltered field exposures of brass (15, and 20 wt.% Zn) and copper sheet have been conducted in three European cities (Milan, Stockholm, Madrid) to generate an in-depth time-dependent understanding of patina evolution, corrosion rates, aesthetic appearance, metal release and degree of dezincification in relation to detailed bulk and surface characteristics prior to exposure. This has been accomplished by using a multitude of surface and bulk analytical tools, chemical analysis and colorimetric investigations. Small differences in surface finish and local variations in nobility observed for the non-exposed brass alloys resulted in slight differences in corrosion initiation. Despite different kinetic behaviour and relative surface distributions of zinc- and copper-rich patina constituents, similar phases were identified with copper-rich phases rapidly dominating the outermost patina layer in Milan, compared to Madrid and Stockholm showing both copper- and zinc-rich phases. As a consequence of differences in surface coverage of copper- and zinc-rich corrosion products at the different sites, the release ratios of copper to zinc varied concordantly. The released amount of zinc to copper (Zn/Cu) was for both alloys and test sites always higher compared to the bulk composition showing a preferential release of zinc. The amount of released copper from the brass alloys was on an average 30-40% lower compared to copper sheet at all test sites investigated. Significantly lower annual total release rates of copper and zinc compared with annual corrosion rates were evident for both brass alloys at all sites.

Corrosion behaviour and biocompatibility of a novel Ni-free intermetallic coating growth on austenitic steel by hot dipping in an Al-12.6%Si alloy.

Commercial 316 LVM austenitic stainless steel samples have been coated by immersion in a bath of molten Al-12.6%Si alloy for 120 s. The coating consists of the Al(12)(Fe,Cr)(3)Si(2) intermetallic. In vitro corrosion behaviour has been evaluated in the Ringer's solution by means of potentiodynamic curves and electrochemical impedance spectroscopy. The results reveal that the coated specimens exhibit lower susceptibility to localised corrosion with respect to the substrate. XPS analysis suggests that the ennoblement of the pitting potential is due to the formation of a chromium oxyhydroxide containing passive layer. The intermetallic coating shows a good biocompatibility, as demonstrated by culturing human mesenchymal stem cells isolated from bone marrow which attached, grew and differentiated to the osteoblastic lineage to a similar extent on coated and bare steels. In summary, this study proposes a method that generates Ni-free coatings of the stainless steel with useful properties for biomedical applications.

Discrimination and mental health in Ecuadorian immigrants in Spain.

BACKGROUND: The aim of this study was to examine the effects of ethnic discrimination on the mental health of Ecuadorian immigrants in Spain and to assess the roles of material and social resources. METHODS: Data were taken from the "Neighbourhood characteristics, immigration and mental health" survey conducted in 2006 in Spain. Psychological distress measured as "Possible Psychiatric Case" (PPC) was measured by the GHQ-28. A logistic regression was fitted to assess the association between PPC and discrimination. Interactions of discrimination with social and material resources were tested using product terms. RESULTS: Some 28% of the participants met our definition of PPC. About 20% of those who reported no discrimination were PPCs, rising to 30% of those who sometimes felt discriminated against and 41% of those who continually perceived discrimination. The OR for continuous discrimination was 12 (95% CI 3.5 to 40.3) among those with high financial strain, and 10 (2.4 to 41.7) when there was lack of economic support. Emotional support had an independent effect on PPC (OR 1.8, 95% CI 1.0 to 3.6, for those who reported having no friends). Social integration through a community group or association was positively related to the probability of being a PPC (OR 1.7, 95% CI 1.0 to 2.9). CONCLUSION: Ethnic discrimination is associated with psychological distress in these Ecuadorian immigrants in Spain. Discrimination effects may be exacerbated among those facing economic stress and those without economic support. These particularly vulnerable immigrants should be the subject of social and health interventions.

Incidence and risk factors for tuberculosis in HIV-positive subjects by HAART status.

OBJECTIVE: To estimate incidence rates and risk factors for tuberculosis (TB) in human immunodeficiency virus seroprevalent subjects. METHODS: Multicentre, hospital-based cohort study of patients presenting to 10 Spanish hospitals from 1 January 1997 to 31 December 2003. Poisson regression was used and highly active antiretroviral treatment (HAART) was modelled as a time-dependent covariate. RESULTS: A total of 4268 patients were followed for a median of 3.8 years; 221 TB cases were diagnosed over 16 464 person-years (py). TB rates were higher in HAART-naïve subjects (1.56 per 100 py, 95%CI 1.36-1.79) than those on HAART (0.5/100 py, 95%CI 0.31-0.80). Among HAART-naïves, TB risk factors were: being male, being an injecting drug user (IDU) (RR 2.01, 95%CI 1.28-3.16), having low CD4 counts (P < 0.001) and high viral loads (P < 0.001). HAART was protective (RR 0.26, 95%CI 0.16-0.40) and reductions in TB rates were observed in the last calendar period (RR 0.74, 95%CI 0.55-1.00). For patients on HAART, no differences were observed by category of transmission. Low CD4 counts at entry were associated with higher TB rates (P < 0.001). CONCLUSIONS: HAART was associated with lower TB rates, and TB risk factors differed according to whether or not patients had received HAART. To further reduce TB rates, additional strategies are needed, such as timely access and adherence to HAART, especially in IDUs.

Lymphocytic interstitial pneumonia and pulmonary embolism in a patient with tetralogy of Fallot and common variable immunodeficiency: is there any link?

We report the simultaneous occurrence of lymphocytic interstitial pneumonitis and pulmonary embolism in a patient with tetralogy of Fallot and common variable immunodeficiency. An explanation based on the pathogenesis of these diseases is proposed to explain this "unfortunate coincidence".

Anemia hemolítica en relación con una dehiscencia de prótesis mitral biológica / Hemolytic anemia related to a dehiscence of biological mitral prosthesis

Se describe el caso de un paciente con una valvulopatía mitral y aórtica que desarrolla una anemia hemolítica grave junto a una angina inestable. Inicialmente se atribuyó la anemia a un mecanismo autoinmune y se probaron distintos tratamientos con escasa respuesta clínica. La hemólisis finalmente desapareció tras la corrección quirúrgica de la valvulopatía. Hacemos una revisión de la literatura sobre la asociación entre anemia hemolítica y prótesis valvulares, los hallazgos ecocardiográficos en las situaciones de hemólisis importante y el tratamiento de estos casos (AU)

[Emergency room admissions in cocaine users in Spanish hospitals: first evidences of acute complications related to crack use. Work Group for the Study of Emergencies from Psychostimulants]. / Urgencias en consumidores de cocaína en varios hospitales españoles: primeras evidencias de complicaciones agudas por consumo de crack. Grupo de Trabajo para el Estudio de Urgencias por Psicoestimulantes.

BACKGROUND: Acute complications of cocaine are increasing in Spain, nevertheless little information is available on its clinical and toxicological characteristics. MATERIAL AND METHOD: Records from medical emergency rooms of 14 hospitals from Madrid, Valencia and Gran Canaria were reviewed. Records were selected if the term "cocaine" was mentioned, excluding those related with injuries or obstetric, gynecologic and pediatric problems. Emergency room episodes were classified in three groups according its relation with cocaine use. RESULTS: 223 episodes were directly related to cocaine, some of these simultaneously related to heroin (36%) or alcohol. The proportion of all emergency room episodes related to cocaine was threefold higher in Gran Canaria than in Madrid and Valencia. In Gran Canaria most of episodes (72%) were related to cocaine smoking, generally crack, but in Madrid and Valencia most were due to intravenous cocaine use. The most common signs and symptoms were anxiety, mydriasis, syncope, tachycardia, shortness of breath, confusion or coma, agitation, chest pain and palpitations. Mental disorders were the most common diagnoses. 13% of patients were admitted as inpatients to hospital or were referred to another hospital (23.6, 17.3 and 2.2%, if cocaine was smoked, injected and sniffed, respectively). Cardiovascular diagnosis were less frequent in episodes simultaneously related to opioids than in not opioids-related episodes (1.1% vs 10.7%; p = 0.005). Furthermore, 219 not cocaine-related episodes were identified. The relation to cocaine could not be established in other 275 episodes. CONCLUSIONS: This work show for the first time in Spain the presence of crack-related emergency episodes and suggests that injecting and smoking cocaine has a greater impact on public health than sniffing this drug.

[Epidemiology of designer drug use in Spain]. / Epidemiología del consumo de drogas de diseño en España.

BACKGROUND: To provide epidemiological information on the extent of design drug use in Spain, the characteristics of users, and the types of substances consumed. MATERIALS AND METHODS: We analyzed two surveys on drug use carried out in 1993 and 1994 (one in the general population older than 15 years and the other in heroin and/or cocaine users who were not in treatment) as well as data on designer drug seizures confiscated by the General Police Headquarters and Ministry of Health laboratories. RESULTS: According to the general population survey, 4.5% of persons 16-40 years of age have tried design drugs at some time, 2.1% more than once, and 0.6% are current users. Design drug use is associated with age of 20-24 years and use of crack (odds ratio [OR] = 28.6), cannabis (OR = 12.5), cocaine (OR = 7.6) or heroin (OR = 3.8). According to the survey of heroin/cocaine users, 25% of cocaine users have used design drugs in the last 30 days, 11% of heroin users, and 18% of those who use both substances. Use is associated with the use of hallucinogens (OR = 4.8), non-use of the injected route (OR = 2), and having been interviewed in recreational areas (OR = 1.8). Police data reflect a stability in the quantities of amphetamines confiscated, a large increase in those of MDMA, and an absence of MDA and MDEA. Ministry of Health laboratories show an increase in confiscations of amphetamines and the presence of MDA, MDMA and MDEA in all years and areas studied, as well as the appearance of MBDB in 1994. CONCLUSIONS: The occasional use of different design drugs has spread to some degree among young people, varies considerably by geographic region, and is associated with the use of other legal and illegal substances, specially stimulants.

[Emergencies associated with the consumption of designer drugs, hallucinogens and amphetamines treated at 15 Spanish hospitals in 1994. Work Group on the Study of Emergencies due to Psychostimulants]. / Urgencias relacionadas con el consumo de drogas de diseño, alucinógenos y anfetaminas atendidas en quince hospitales españoles durante 1994. Grupo de Trabajo para el Estudio de las Urgencias por Psicoestimulantes.

The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.

[Intravenous drug addiction and the risk of HIV infection in Madrid in 1990]. / Drogadicción intravenosa y riesgo de infección por VIH en Madrid 1990.

As part of a multicenter WHO study on HIV infection among drug injectors, 472 intravenous drug users (IDUs) were interviewed, 240 recruited in the streets and 232 at drug treatment centers. The objectives of the study were to assess the prevalence of HIV infection among IDUs of Madrid, to identify factors associated with risk reduction behaviors, such as the use of sterile syringes and condoms. Chi-square and logistic regression were used to test for differences and to estimate odds ratios. Prevalence of HIV infection among IDUs in Madrid was 50% (53% among those recruited in the street and 38% among those recruited at treatment centers). Forty five per cent of those interviewed were still sharing syringes. Out of the 315 sexually active subjects, only 22% reported using condoms always or almost always. These results suggest that a range of interventions should be implemented to promote change towards healthier behaviors, including syringe-exchange programs, methadone maintenance treatments and pre- and post-test counseling in those agencies which care for this population.