Factores de riesgo para la presentación de complicaciones médicas en enfermos con fractura de cadera / Risk factors for the development of medical complications in patients with hip fracture

Objetivo. Analizar las características de los pacientes hospitalizados con fractura de cadera y su evolución clínica, así como evaluar qué factores se asocian a un mayor riesgo de complicaciones médicas durante el ingreso. Métodos. Estudio prospectivo de los enfermos mayores de 65 años ingresados con fractura de cadera en el Servicio de Traumatología del Complexo Hospitalario Xeral-Calde de Lugo durante el año 2008. Se recogieron diferentes datos clínicos analíticos relativos al estado basal de salud, las características de la fractura y las complicaciones hospitalarias. Se determinaron los factores asociados al desarrollo de la variable compuesta por aparición de complicaciones médicas mayores o fallecimiento durante el ingreso hospitalario, mediante análisis univariable y multivariable. Resultados. Se estudió a 258 pacientes, media (DE) de edad 82,2 (9,5) años, el 76% mujeres. La fractura fue osteoporótica en el 96,8% y fueron operados el 92,6% de los enfermos. El índice de Barthel medio fue 72,9 (25,7) y el de comorbilidad de Charlson medio ajustado por edad 5,2 (1,5). El 63,9% presentó alguna complicación médica mayor durante el ingreso hospitalario. Fallecieron 15 enfermos (5,8%). Las siguientes variables se asociaron al riesgo de aparición de complicaciones médicas: índice de Barthel (OR=2,21; IC del 95%, 1,1-4,25; p=0,01), edad (OR=1,09; IC del 95%, 1,02-1,12; p=0,006), hemoglobina al ingreso (OR=0,76; IC del 95%, 0,62-0,93; p=0,01). Conclusiones. Los enfermos con fractura de cadera son ancianos frágiles, con un importante grado de dependencia y comorbilidad. Es posible identificar al ingreso a aquellos con un mayor riesgo de presentar complicaciones médicas durante su estancia hospitalaria(AU)

Objective. To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications. Methods. Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses. Results. A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01). Conclusions. Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission(AU)

[Risk factors for the development of medical complications in patients with hip fracture]. / Factores de riesgo para la presentación de complicaciones médicas en enfermos con fractura de cadera.

OBJECTIVE: To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications. METHODS: Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses. RESULTS: A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01). CONCLUSIONS: Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission.

[Analysis of the investigation activity of the internist from the Public Bid of Employment in Galicia]. / Análisis de la actividad investigadora de los internistas gallegos a partir de los resultados de la oferta pública de empleo.

OBJECTIVES: The aim of the present study was to assess the investigative activity of the internists. Data were collected from the Public Bid of Employment (PBE) performed in Galicia in 2005, and compared with the rest of medical subspecialities. METHODS: The results from the PBE related to internal medicine and medical subspecialities are available in the web page of the Galician Service of Health. The following data were studied: speciality, sex, method of attainment of the specialist degree, thesis, and scores obtained in Galician language exam, professional experience, professional report, postgraduate teaching and published scientific papers. RESULTS: Data from 355 specialists were analyzed: 118 (33.2%) were internists, and 237 (66.8%) were medical subspecialists. There were no differences between internal medicine and the rest of subspecialities in terms of sex, method of attainment of the specialist degree, thesis, and scores obtained in Galician language exam, professional experience and postgraduate teaching. Internists presented fewer scientific papers than subspecialists, even when they were classified according to different levels of professional experience. Degrees obtained by the MIR system were associated with more publications (p < 0.001). The attainment of the job was associated to scores obtained in the professional report, professional experience, and published scientific papers (p < 0.001). The obtaining of the job was associated to the accomplishment of the doctoral thesis in the university teaching hospitals (A Coruña, Santiago y Vigo, p < 0.005). CONCLUSIONS: The investigative activity of the internists in Galicia is inferior to the rest of the medical subspecialists. It seems necessary to stimulate the internists to developing scientific investigation and to improve those skills of the internal medicine residents.

[Should we use oral replacement for vitamin B12 deficiency as the first option of treatment?]. / 'Debemos utilizar la vía oral como primera opción para el tratamiento del déficit de vitamina B12?

OBJECTIVE: Analyze whether the tablets available in Spain are useful for oral replacement in the treatment of vitamin B12 deficiency. METHODS: From June 2003 to December 2005, patients with vitamin B12 deficiency attended at the Internal Medicine Clinic, were offered the possibility of starting or switching to oral therapy. Clinical and biochemical responses were monitored at baseline and at 2, 4, 6, 12, 18 y 24 months of follow-up. RESULTS: Twenty-eight patients were included (55.6% women), with a mean age of 74.96 +/- 9.98 years. Twenty-three cases (82.1%) had pernicious anemia, and 5 were gastrectomized. Patients who switched from intramuscular to oral therapy (16 cases) showed no decrease in the mean values of hemoglobin and B12 levels during the follow-up. Patients who started on oral therapy showed an increase in the values of hemoglobin (from 9.9 +/- 2.8 g/dl to 13.5 +/- 1.1, p = 0.003) and vitamin B12 (from 118 +/- 50 pg/ml to 496 +/- 229, p = 0.001) as early as two months after baseline, maintaining the response during the follow-up. No patient refused oral therapy and no toxic effect attributed to oral therapy was recorded. CONCLUSIONS: Oral replacement of vitamin B12 deficiency with the tablets available in Spain is safe, effective and acceptable to patients.

¿Debemos utilizar la vía oral como primera opción para el tratamiento del déficit de vitamina B12? / Should we use oral replacement for vitamin B12deficiency as the first option of treatment?

Objetivo. Analizar la utilidad de los preparados comerciales disponibles en nuestro país para el tratamiento del déficit de vitamina B12 por vía oral. Método. Desde junio de 2003 a diciembre de 2005 se ofreció a los pacientes con déficit de vitamina B12 diagnosticados o en seguimiento en una consulta externa de Medicina Interna el inicio del tratamiento por vía oral o el cambio de la vía intramuscular por la oral. Se realizaron controles clínicos y analíticos al inicio del tratamiento oral y a los 2, 4, 6, 12, 18 y 24 meses de seguimiento. Resultados. Se incluyeron en el estudio 28 enfermos (55,6% mujeres), con una edad media de 74,96 ± 9,98 años. Veintitrés casos (82,1%) presentaban anemia perniciosa y 5 estaban gastrectomizados. En los pacientes que recibían tratamiento intramuscular (16 casos) no se observaron diferencias en los valores medios de hemoglobina y vitamina B12 tras cambiar a vía oral. Los enfermos que iniciaron tratamiento directamente por vía oral presentaron ya a los dos meses un ascenso de los valores de hemoglobina (de 9,9 ± 2,8 g/dl a 13,5 ± 1,1, p = 0,003) y vitamina B12 (de 118 ± 50 pg/ml a 496 ± 229, p = 0,001). Estas diferencias se mantuvieron a lo largo de todo el período de seguimiento. Ningún paciente abandonó el tratamiento oral y no se registraron efectos secundarios atribuibles al mismo. Conclusión. La efectividad, seguridad y tolerancia del tratamiento por vía oral del déficit de vitamina B12 con los preparados comerciales disponibles en España son excelentes (AU)

Objective. Analyze whether the tablets available in Spain are useful for oral replacement in the treatment of vitamin B12 deficiency. Methods. From June 2003 to December 2005, patients with vitamin B12 deficiency attended at the Internal Medicine Clinic, were offered the possibility of starting or switching to oral therapy. Clinical and biochemical responses were monitored at baseline and at 2, 4, 6, 12, 18 y 24 months of follow-up. Results. Twenty-eight patients were included (55.6% women), with a mean age of 74.96 ± 9.98 years. Twenty-three cases (82.1%) had pernicious anemia, and 5 were gastrectomized. Patients who switched from intramuscular to oral therapy (16 cases) showed no decrease in the mean values of hemoglobin and B12 levels during the follow-up. Patients who started on oral therapy showed an increase in the values of hemoglobin (from 9.9 ± 2.8 g/dl to 13.5 ± 1.1, p = 0.003) and vitamin B12 (from 118 ± 50 pg/ml to 496 ± 229, p = 0.001) as early as two months after baseline, maintaining the response during the follow-up. No patient refused oral therapy and no toxic effect attributed to oral therapy was recorded. Conclusions. Oral replacement of vitamin B12 deficiency with the tablets available in Spain is safe, effective and acceptable to patients (AU)