Impacto de las fracturas por fragilidad en mujeres españolas con osteoporosis posmenopáusica / Impact of fragility fractures in postmenopausal Spanish women with osteoporosis

Objetivo: dada la repercusión que tienen las fracturas por fragilidad y sus secuelas en la vida de las mujeres con osteoporosis posmenopáusica (OPM), el objetivo de este estudio es describir y analizar su impacto en esta población. Material y métodos: se realizó una encuesta a mujeres posmenopáusicas con fractura por fragilidad en un diseño observacional transversal. Se recogieron variables sociodemográficas, impacto de la fractura (necesidad de cuidados, productividad laboral), calidad de vida relacionada con la salud (CVRS, mediante cuestionario QUALEFFO-31) y disposición a pagar (DAP) por recuperarla. Resultados: participaron 120 mujeres, promedio de edad 62 ± 7 años. Las fracturas más frecuentes fueron las de radio distal (29,9 %) y las vertebrales (21,3 %). Un 53,3 % necesitó cuidados durante su recuperación (76,5 % informales; 24,9 % formales) y un 4,2 % tuvo que ingresar en un centro/residencia sociosanitaria. De aquellas que trabajaban cuando se produjo la fractura (62,5 %), el 56 % vio su vida laboral afectada (69,3 % incapacidad temporal; 17,3 % incapacidad permanente; 10,7 % reducción de jornada; 10,7 % abandono laboral; 5,3 % permiso/excedencia; 3,6 % prejubilación). El impacto de la fractura se debió principalmente al dolor (71,7 %), dificultad para realizar actividades cotidianas (48,3 %), problemas de movilidad (46,7 %) y estado emocional (41,7 %). La mayor DAP se ofreció por recuperar la capacidad para realizar actividades cotidianas y el estado emocional. La puntuación total QUALEFFO-31 (0-100) fue 49,9 ± 10,8 (función mental: 68,3 ± 7,3; dolor: 56 ± 22,6; función física: 39,3 ± 15,5). Conclusiones: las fracturas por fragilidad tienen un alto impacto en la calidad de vida de las mujeres con OPM. Resulta fundamental poner en valor aquellos aspectos que más les preocupan para optimizar su abordaje. (AU)

Objective: Given the impact of fragility fractures and their consequences on the lives of women with postmenopausal osteoporosis (PMO), the objective of this study is to describe and analyze the impact of this kind of fractures on this population. Materials and methods: A survey was conducted among postmenopausal women with fragility fractures in a cross-sectional observational design. Sociodemographic variables, fracture impact (need for care, work productivity), and data on health-related quality of life (HRQoL, assessed using the QUALEFFO-31 questionnaire), and willingness to pay (WTP) to regain HRQoL were collected. Results: A total of 120 women participated, with a mean age of 62 ± 7 years. The most frequent fractures described were distal radius fractures (29.9 %), followed by vertebral fractures (21.3 %). A total of 53.3 % required care during their recovery (76.5 %, informal; 24.9 %, formal), and 4.2 % had to be admitted to a health care or nursing home. Among those who were working when the fracture occurred (62.5 %), 56 % had their working life affected (69.3 %, temporary disability; 17.3 %, permanent disability; 10.7 %, reduced working hours; 10.7 %, quit their jobs; 5.3 %, leave of absence; and 3.6 %, early retirement). The impact of the fracture was primarily due to pain (71.7 %), difficulty performing activities of daily living (48.3 %), mobility problems (46.7 %), and emotional state (41.7 %). The highest WTP was offered to regain the ability to perform activities of daily living and improve the emotional state. The overall QUALEFFO-31 score (0-100) was 49.9 ± 10.8 (mental function, 68.3 ± 7.3; pain, 56 ± 22.6; physical function, 39.3 ± 15.5). Conclusions: Fragility fractures play a significant role on the quality of life of women with PMO. It is of paramount importance to value the aspects that concern them the most to optimize their management. (AU)

Global Subjective Assessment and Mini Nutritional Assessment Short Form Better Predict Mortality Than GLIM Malnutrition Criteria in Elderly Patients with Hip Fracture.

The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. METHODS: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. RESULTS: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3-25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3-11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02-13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3-8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35-6.7; p = 0.007] at 12 months. CONCLUSION: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.

Leucocyte- and platelet-rich fibrin (L-PRF) as a regenerative medicine strategy for the treatment of refractory leg ulcers: a prospective cohort study.

Chronic wounds (VLU: venous leg ulcer, DFU: diabetic foot ulcer, PU: pressure ulcer, or complex wounds) affect a significant proportion of the population. Despite appropriate standard wound care, such ulcers unfortunately may remain open for months or even years. The use of leukocyte- and platelet-rich fibrin (L-PRF) to cure skin ulcers is a simple and inexpensive method, widely used in some countries but unknown or neglected in most others. This auto-controlled prospective cohort study explored and quantified accurately for the first time the adjunctive benefits of topical applications of L-PRF in the management of such refractory ulcers in a diverse group of patients. Forty-four consecutive patients with VLUs (n = 28, 32 wounds: 17 ≤ 10 cm2 and 15 > 10 cm2), DPUs (n = 9, 10 wounds), PUs (n = 5), or complex wounds (n = 2), all refractory to standard treatment for ≥3 months, received a weekly application of L-PRF membranes. L-PRF was prepared following the original L-PRF method developed more than 15 years ago (400g, 12 minutes) using the Intra-Spin L-PRF centrifuge/system and the XPression box kit (Intra-Lock, Boca Raton, FL, USA; the only CE/FDA cleared system for the preparation of L-PRF). Changes in wound area were recorded longitudinally via digital planimetry. Adverse events and pain levels were also registered. All wounds showed significant improvements after the L-PRF therapy. All VLUs ≤ 10 cm2, all DFUs, as well as the two complex wounds showed full closure within a 3-month period. All wounds of patients with VLUs > 10 cm2 who continued therapy (10 wounds) could be closed, whereas in the five patients who discontinued therapy improvement of wound size was observed. Two out of the five PUs were closed, with improvement in the remaining three patients who again interrupted therapy (surface evolution from 7.35 ± 4.31 cm2 to 5.78 ± 3.81 cm2). No adverse events were observed. A topical application of L-PRF on chronic ulcers, recalcitrant to standard wound care, promotes healing and wound closure in all patients following the treatment. This new therapy is simple, safe and inexpensive, and should be considered a relevant therapeutic option for all refractory skin ulcers.

Effect of apical size and taper on volume of irrigant delivered at working length with apical negative pressure at different root curvatures.

INTRODUCTION: The purpose of this investigation was to determine the effect that apical preparation size and preparation taper have on the volume of irrigant delivered at the working length for different canal curvatures using apical negative pressure irrigation. METHODS: One hundred fifty-five human teeth (55 maxillary canines and 100 mandibular molars) were used in this study. Root canals were prepared with rotary instruments to a size 35.04 and separated into 3 experimental groups according to their degree of curvature: group A (n = 50) included canal curvatures ranging from 0° to 10°, group B (n = 50) from 11° to 30°, and group C (n = 50) from 31° to 65°. Samples of each curvature group were further randomized to experimental subgroups according to the apical size and taper as follow: 35.06, 40.04, 40.06, 45.04, and 45.06. The apical third was irrigated using a microcannula and the volume of NaOCl suctioned at the working length under negative pressure was measured over a period of 30 seconds using a fluid recovery trap. Positive controls consisted of measuring the maximum volume of 5.25% NaOCl capable of being suctioned by the microcannula from an open glass vial over 30 seconds. Negative control was the volume of irrigant aspirated by the microcannula with a preparation size of 25.04 over 30 seconds. RESULTS: The volume of irrigant was significantly greater when the apical preparation size increased from 35.06 to 40.04. As the apical preparation taper increased further from 40.04 to 40.06, the volume of irrigant significantly improved in group B, but it was not significant in group A. Apical preparation sizes greater than 40.06 did not show an increase of the volume of irrigant aspirated. CONCLUSIONS: The degree of root canal curvature decreased the volume of irrigant at the working length for a given apical size and taper. An apical preparation of 40.06 significantly increased the volume and exchange of irrigant at the working length regardless of curvature.

Desarrollo embrionariolarval y tiempo de metamorfosis del pez tropical Xenomelaniris brasiliensis (Pisces: Atherinidae) / Development of the tropical fish Xenomelaniris brasiliensis (Pisces: Atherinidae) from embryo to larva and time to metamorphosis

Embryoniclarval development, and metamorphosis larval time, were studied in the tropical fish Xenomelaniris brasiliensis. Twenty nine sexually mature specimens were used, 16 females (10.86 ± 1.01 cm and 7.63 ± 2.62 g) and 13 males (10.43 ± 0.57 cm and 6.54 ± 1.44 g) which produced gametes through abdominal massage. Fertilized eggs were spherical (1.18 ± 0.44 mm diameter), greenish, transparent, benthonic and vitelusrich; rugose striated chorion with numerous external filaments randomly distributed and abundant oil globules (0.11 ± 0.07 mm diameter). The embryonic development was finished at 26.36 ± 2.03ºC, 39.67 ± 0.58 PSU and pH 8.30 ± 0.10. Larvae (4.56 ± 0.97 mm total length) hatched at 143 hours and 19 minutes, with vitteline sac vestiges and a single oil globule. The larvae were fed on Brachionus plicatilis and Isochrysis galbana. After the second week Artemia nauplii were added and I. galbana maintained. Flexion started 13 days after larvae hatched (6.10 ± 1.54 mm total length) and was completed 32 days later (11.25 ± 1.87 mm total length) with the hipural complex completely developed. In conclusion, X. brasiliensis showed direct larval development and started larval metamorphosis (13.08 ± 2.07 mm total length) to juvenile 40 days after hatching

Se describe el desarrollo embrionario y larval hasta la metamorfosis de Xenomelaniris brasiliensi. Un total de 29 ejemplares sexualmente maduros, 16 hembras (10.86 ± 1.01 cm y 7.63 ± 2.62 g) y 13 machos (10.43 ± 0.57 cm y 6.54 ± 1.44 g), liberaron sus productos sexuales mediante masaje abdominal. Los huevos fértiles fueron esféricos de 1.18 ± 0.44 mm de diámetro, verdosos, translúcidos, bentónicos, ricos en vitelo, corion rugoso y estriado, con numerosos filamentos coriónicos, distribuidos aleatoriamente por toda la superficie externa y numerosas gotas lipídicas con un diámetro de 0.11 ± 0.07 mm. El desarrollo embrionario se realizó a 26.36 ± 2.03 ºC, 39.67 ± 0.58 PSU y pH 8.30 ± 0.10 eclosionando larvas de 4.56 ± 0.97 mm a las 143 hrs: 19 min, con vestigios del saco vitelino y una gota lipídica interna. Las larvas fueron alimentadas diariamente con Brachionus plicatilis e Isochrysis galbana, a partir de la segunda semana se incorporó nauplios de Artemia, manteniendo la adición diaria de I. galbana. A los 13 días después de la eclosión de larvas (6.10 ± 1.54 mm) se inició la flexión, completándose a los 32 días (11.25 ± 1.87 mm) con un complejo hipural completamente desarrollado. Se concluye que X. brasiliensis presentó desarrollo larval directo, iniciándose la metamorfosis de larva (13.08 ± 2.07) a juvenil a los 40 días de edad

Evaluación de la eficacia del tratamiento ambulatorio en la Unidad de Triage del Servicio de Psiquiatría del Hospital del Salvador / The effectiveness evaluation of the ambulatory treatment in the Triage Unit of the Hospital del Salvador Psiquiatric Service

La evaluación de la eficacia de las psicoterapias es de interés creciente en materia de Salud Mental. A tal efecto, existen pruebas internacionales recientes sobre su costo-eficacia. Los resultados funcionan como determinantes en la toma de decisiones en el área de Salud: esto impone a los clínicos la necesidad de actualizar su práctica a través de estrategias de evaluación de resultados. Para demostrar que un tratamiento es beneficioso para un paciente es fundamental contar con instrumentos estandarizados eficaces en la evaluación del cambio terapéutico, por medio de indicadores observables y cuantificables. Lambert y cols, en 1996, desarrollaron el cuestionario OQ45.2 que mide externamente los avances del paciente a lo largo de la psicoterapia. Dicho cuestionario fue validado en Chile en el año 2000 por Von Bergen y De la Parra, la escala mide qué síntomas presenta la persona, cómo se está relacionando con los otros significativos y cuál es su rol social laboral. El presente trabajo muestra los resultados de su aplicación secuencial en la Unidad de Triage del Servicio de Psiquiatría del Hospital del Salvador: midiendo la eficacia del proceso terapéutico y obteniendo resultados cuantitativos del éxito o fracaso de las intervenciones.

[Development of the tropical fish Xenomelaniris brasiliensis (Pisces: Atherinidae) from embryo to larva and time to metamorphosis]. / Desarrollo embrionario-larval y tiempo de metamorfosis del pez tropical Xenomelaniris brasiliensis (Pisces: Atherinidae).

Embryonic-larval development, and metamorphosis larval time, were studied in the tropical fish Xenomelaniris brasiliensis. Twenty nine sexually mature specimens were used, 16 females (10.86+/-1.01 cm and 7.63+/-2.62 g) and 13 males (10.43+/-0.57 cm and 6.54+/-1.44 g) which produced gametes through abdominal massage. Fertilized eggs were spherical (1.18 +/-0.44 mm diameter), greenish, transparent, benthonic and vitelus-rich; rugose striated chorion with numerous external filaments randomly distributed and abundant oil globules (0.11 + 0.07 mm diameter). The embryonic development was finished at 26.36+/-2.03 degrees C, 39.67+/-0.58 PSU and pH 8.30+/-0.10. Larvae (4.56+/-0.97 mm total length) hatched at 143 hours and 19 minutes. with vitteline sac vestiges and a single oil globule. The larvae were fed on Brachionus plicatilis and Isochrysis galbana. After the second week .4rtemia nauplii were added and I. galbana maintained. Flexion started 13 days after larvae hatched (6.10+/-1.54 mm total length) and was completed 32 days later (11.25+/-1.87 mm total length) with the hipural complex completely developed. In conclusion, X brasiliensis showed direct larval development and started larval metamorphosis (13.08+/-2.07 mm total length) to juvenile 40 days after hatching.