[Effect of nutritional status on mortality and functional recovery in older adults with hip fracture]. / Efecto del estado nutricional en la mortalidad y recuperación funcional en adultos mayores con fractura de cadera.

INTRODUCTION: Malnutrition is a common problem in the elderly population but has not been fully studied in elderly people with hip fractures. The goal is to estimate annual mortality based on nutrition in the elderly with hip fracture and compare motor functionality. MATERIAL AND METHODS: Retrospective cohort of patients over 65 years of age with hip fracture included in the Institutional Register of The Elderly with Hip Fracture of a University Hospital, between July 2014 and July 2018. Nutritional status with Mini Nutritional Assessment Short-Form (MNA-SF) was assessed at hospital admission. Motor functional capacity was evaluated with Parker Scale (PS) basal, at three and 12 months. RESULTS: 1,253 patients were included. 49.92% (CI95% 47.12-52.72) were malnourished. The annual mortality of the well-nourished (WN) was 9.45% (CI95% 7.23-12.30) against 21.52% (CI95% 18.12-25.45; p 0.001) of the malnourished (MN). The risk of death was associated with malnutrition HR 2.45 (CI95% 1.75-3.43; p 0.001). After adjusting it by age, sex, fragility, AVD, Charlson comorbility index and dementia, the risk remained HR 1.71 (CI95% 17-2.49; p = 0.005). With respect to functionality, the basal Parker Scale median (EP) for the WN group was 9 (RIC6-9) and for MN was 5 (RIC3-9) p 0.001, 6 months (RIC3-6) and 4 (RIC2-6) p 0.001 and 12 months 6 (RIC4-7) and 3 (RIC2-6) p 0.001. CONCLUSIONS: There is an association between the malnutrition of the elderly with hip fracture and its mortality with a year of evaluation; we also find a difference in motor functionality.

INTRODUCCIÓN: La malnutrición es una problemática frecuente en la población anciana, pero no ha sido completamente estudiado en ancianos con fractura de cadera. El objetivo es estimar mortalidad anual según nutrición en ancianos con fractura de cadera y comparar la funcionalidad motora. MATERIAL Y MÉTODOS: Cohorte retrospectiva de pacientes mayores de 65 años con fractura de cadera incluidos en el Registro Institucional de Ancianos con Fractura de Cadera de un Hospital Universitario, entre Julio de 2014 y Julio de 2018. Se evaluó el estado nutricional con Mini Nutritional Assessment Short-Form (MNA-SF) al ingreso hospitalario. La capacidad funcional motora fue evaluada con escala de Parker (EP) basal, a los tres y 12 meses. RESULTADOS: Se incluyeron 1,253 pacientes. 49.92% (IC95% 47.12-52.72) estaba malnutrido. La mortalidad anual de los bien nutridos (BN) fue de 9.45% (IC95% 7.23-12.30) contra 21.52% (IC95% 18.12-25.45; p 0.001) de los malnutridos (MN). El riesgo de muerte se asoció a la malnutrición HR 2.45 (IC95% 1.75-3.43; p 0.001). Luego de ajustarlo por edad, sexo, fragilidad, AVD, índice de comorbilidades de Charlson y demencia, el riesgo se mantuvo HR 1.71 (IC95% 17-2.49; p = 0.005). Con respecto a la funcionalidad, la mediana de la escala de Parker (EP) basal para el grupo BN fue 9 (RIC6-9) y para MN fue 5 (RIC3-9) p 0.001, a los tres meses 6 (RIC3-6) y 4 (RIC2-6) p 0.001 y a los 12 meses 6 (RIC4-7) y 3 (RIC2-6) p 0.001. CONCLUSIONES: Existe asociación entre la malnutrición del anciano con fractura de cadera y su mortalidad al año, asimismo una diferencia en la funcionalidad motora.

Survival and functionality in the elderly over 85 years of age with hip fracture. / Supervivencia y funcionalidad en ancianos mayores de 85 años con fractura de cadera.

BACKGROUND: There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS: A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS: We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS: Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.

Efecto del estado nutricional en la mortalidad y recuperación funcional en adultos mayores con fractura de cadera / Effect of nutritional status on mortality and functional recovery in older adults with hip fracture

Resumen: Introducción: La malnutrición es una problemática frecuente en la población anciana, pero no ha sido completamente estudiado en ancianos con fractura de cadera. El objetivo es estimar mortalidad anual según nutrición en ancianos con fractura de cadera y comparar la funcionalidad motora. Material y métodos: Cohorte retrospectiva de pacientes mayores de 65 años con fractura de cadera incluidos en el Registro Institucional de Ancianos con Fractura de Cadera de un Hospital Universitario, entre Julio de 2014 y Julio de 2018. Se evaluó el estado nutricional con Mini Nutritional Assessment Short-Form (MNA-SF) al ingreso hospitalario. La capacidad funcional motora fue evaluada con escala de Parker (EP) basal, a los tres y 12 meses. Resultados: Se incluyeron 1,253 pacientes. 49.92% (IC95% 47.12-52.72) estaba malnutrido. La mortalidad anual de los bien nutridos (BN) fue de 9.45% (IC95% 7.23-12.30) contra 21.52% (IC95% 18.12-25.45; p ≤ 0.001) de los malnutridos (MN). El riesgo de muerte se asoció a la malnutrición HR 2.45 (IC95% 1.75-3.43; p ≤ 0.001). Luego de ajustarlo por edad, sexo, fragilidad, AVD, índice de comorbilidades de Charlson y demencia, el riesgo se mantuvo HR 1.71 (IC95% 17-2.49; p = 0.005). Con respecto a la funcionalidad, la mediana de la escala de Parker (EP) basal para el grupo BN fue 9 (RIC6-9) y para MN fue 5 (RIC3-9) p < 0.001, a los tres meses 6 (RIC3-6) y 4 (RIC2-6) p ≤ 0.001 y a los 12 meses 6 (RIC4-7) y 3 (RIC2-6) p < 0.001. Conclusiones: Existe asociación entre la malnutrición del anciano con fractura de cadera y su mortalidad al año, asimismo una diferencia en la funcionalidad motora.

Abstract: Introduction: Malnutrition is a common problem in the elderly population but has not been fully studied in elderly people with hip fractures. The goal is to estimate annual mortality based on nutrition in the elderly with hip fracture and compare motor functionality. Material and methods: Retrospective cohort of patients over 65 years of age with hip fracture included in the Institutional Register of The Elderly with Hip Fracture of a University Hospital, between July 2014 and July 2018. Nutritional status with Mini Nutritional Assessment Short-Form (MNA-SF) was assessed at hospital admission. Motor functional capacity was evaluated with Parker Scale (PS) basal, at three and 12 months. Results: 1,253 patients were included. 49.92% (CI95% 47.12-52.72) were malnourished. The annual mortality of the well-nourished (WN) was 9.45% (CI95% 7.23-12.30) against 21.52% (CI95% 18.12-25.45; p ≤ 0.001) of the malnourished (MN). The risk of death was associated with malnutrition HR 2.45 (CI95% 1.75-3.43; p ≤ 0.001). After adjusting it by age, sex, fragility, AVD, Charlson comorbility index and dementia, the risk remained HR 1.71 (CI95% 17-2.49; p = 0.005). With respect to functionality, the basal Parker Scale median (EP) for the WN group was 9 (RIC6-9) and for MN was 5 (RIC3-9) p < 0.001, 6 months (RIC3-6) and 4 (RIC2-6) p ≤ 0.001 and 12 months 6 (RIC4-7) and 3 (RIC2-6) p < 0.001. Conclusions: There is an association between the malnutrition of the elderly with hip fracture and its mortality with a year of evaluation; we also find a difference in motor functionality.

Medical and agricultural entomology in Brazil: a historical approach.

Medical Entomology emerged in Brazil in the late nineteenth century, through the initiative of a group of physicians dedicated to researching microorganisms related to diseases of public health importance, especially yellow fever and malaria. They led the institutionalization of Bacteriology and Tropical Medicine in southeast Brazil and the sanitation of coastal cities and, subsequently, rural areas. Medical Entomology provided the professionals who would undertake campaigns against agricultural plagues, as well as the institutionalization of Agronomy and Veterinary Medicine. In the present article, I intend to show how relations between the professionals who gave life to Medical Entomology in Brazil were interwoven and to illustrate their relations with entomologists in other countries. I will also present an overview of the research problems faced by Brazilian entomologists at the turn of the nineteenth century and early decades of the twentieth.

Adolpho Lutz and the origins of medical entomology in Brazil.

Adolpho Lutz (1855-1940) formed a bridge between the Bahian Tropicalist School and post-Mansonian medicine. Before taking over as head of the São Paulo Bacteriological Institute (1893), Lutz traveled through a variety of regions and delved into various disciplines. In the 1880s, he was already arguing that leprosy was transmitted by mosquitoes. Carbuncles, cholera, and typhoid fever were then the accepted models for investigating the etiology of infectious diseases. Following the discovery of how malaria was transmitted, attention turned to hematophagous diptera. Physicians, bacteriologists, zoologists, and veterinarians reshaped the network of actors involved in the 'hunt' for the agents and transmitters of diseases, as they began relying on analogies with malaria and yellow fever. Edwin Ray Lankester, director of the British Museum (Natural History), launched then a worldwide investigation into species that might be linked to human disease. The species described by Lutz and his proposed classification system were vital to Frederick Theobald's fundamental work in medical entomology, published in the early twentieth century. In 1908, Lutz brought with him to the Oswaldo Cruz Institute a remarkable quantity of research and experiments in all branches of the newly created "tropical medicine," devoted especially to entomology.

Fight for survival: the life of a Hansens disease sufferer through his correspondence with Adolfpho Lutz / ?

O presente trabalho apresenta a série completa da correspondência da família de um portador do mal de Hansen residente no Maranhão, Nordeste do Brasil, com o médico e bacteriologista Adolpho Lutz. Fabrício Caldas de Oliveira e Numa Pires de Oliveira, pai e filho, mantiveram durante mais de vinte anos intensa troca de cartas com o cientista na busca da cura da doença que vitimava Numa desde criança. As 24 cartas aqui reunidas retratam, de maneira única, o drama médico-social enfrentado por esta família, os resultados do uso do chalmugra e outros medicamentos, a busca de tratamentos alternativos

Asimetría en el hiperparatiroidismo secundario renal: una revisión teórico analítica / Renal secundary hyperparathyroidsm: an analytical theorical review

La asimetría del hiperparatiroidismo en la insuficinecia renal crónica es muy infrecuente y está poco estudiado, algunos autores lo atribuyen a inactivación del gen supresor tumoral del cromosoma 11, actividades de oncogénes, modificación en los receptores de vitamina D y otros factores tróficos. A propósito de una revisión teórico-analítica de los archivos de anatomía patológica del Hospital Miguel Pérez Carreño (HMPC), Caracas, Venezuela período 1994-1998. Se encontró de 21.000 biopsias generales, dos casos de esta patología. Se realizó una revisión teórico-analítica para destacar los planteamientos hechos sobre dicho tópico

[Domingos José Freire and the beginnings of bacteriology in Brazil]. / Domingos José Freire e os primórdios da bacteriologia no Brasil.

The article examines the trajectory of Domingos José Freire, a bacteriologist who attained great national and international renown in the final quarter of the last century for claiming to have discovered the yellow-fever microbe and a vaccine that was administered to thousands of people. The article reviews the main controversies protagonized by this scientist and endeavors to show the role be played in the enthronement of Pasteurian medicine in Brazil.

Papilotomia descendente sob controle endoscópico em pacientes com dreno em T / Descending papillotomy under endoscopy in patients with a T-drain

Os autores apresentam três casos de papilotomia endoscópica descendente (através do dreno em T), com a utilizaçäo (técnica dos autores) ou näo (técnica de Wurbs) de cateter com controle proximal. Esta técnica pareceu aos autores extremamente simples e de fácil execuçäo