ABSTRACT
An observational study was carried out in two hospitals in patients > 65 years admitted for hip fracture. At 6 months, 15% of patients in the hospital with orthogeriatric standard care and 75% in the hospital with fracture liaison service were receiving bisphosphonates. PURPOSE: Many patients with fractures are discharged without preventive therapy against further fractures. We sought to compare the effectiveness of an orthogeriatric fracture liaison service (FLS), outpatient FLS, and the standard care after hip fractures in prevention of future fractures. METHODS: An observational study was carried out in two hospitals in patients > 65 years of age, admitted between March and July 2016 for fractures. The Candelaria hospital (HUNSC) has no specific protocol for secondary prevention, while at the Negrin Hospital (HUGCDN), an FLS nurse visits the inpatients, gathers metabolic history, instructs regarding the diet, exercises, and fall prevention, and completes a discharge report regarding osteoporosis treatment. The prescription rate of osteoporosis treatment was analyzed at admission, discharge, and 6 months after discharge. We also analyzed the data of patients with hip fractures who attended the outpatient FLS before March 2016. RESULTS: We included a total of 185 inpatients with a mean age of 82 years and 73% were women. At admission, 8% of the patients in HUNSC and 10% in HUGCDN were receiving bisphosphonates. At discharge, the percentages were 8 and 96%, while at 6 months they were 15 and 75%, respectively (p < 0.001). The outpatient FLS recorded 206 hip fractures (27% of discharges for fractures), with 77% adherence to treatment at 6 months. CONCLUSIONS: Compared with the conventional management, the FLS model for inpatients with hip fractures achieved a fivefold increase in the adherence to treatment at 6 months, similar to the rates of outpatient FLS.
Subject(s)
Ambulatory Care/methods , Health Services for the Aged , Hip Fractures/prevention & control , Osteoporotic Fractures/prevention & control , Secondary Prevention/methods , Aged , Aged, 80 and over , Bone Density Conservation Agents/therapeutic use , Diphosphonates/therapeutic use , Female , Humans , Inpatients/statistics & numerical data , Male , Outpatients/statistics & numerical data , Patient ComplianceABSTRACT
BACKGROUND AND OBJECTIVE: Our aim was to conduct a study to define the clinical and epidemiological characteristics of patients with murine typhus in Tenerife island (Canary islands, Spain). Moreover, we investigated the differential clinical features of this disease with regard to Q fever. PATIENTS AND METHOD: 5-year prospective study of patients with murine typhus (1998-2002) admited in a reference hospital in Tenerife, Spain. RESULTS: Thirty two patients were included. Flea bite and rat exposure were iuncommon (6.25%). The monthly distribution showed a peak of incidence in January, August and September, without a clear seasonal prevalence. Fever and headache were the most common clinical features. Rash was present in 28% of the cases. Both an increase in liver enzyme levels (88%) and thrombocytopenia (37.5%) were the most relevant laboratory findings. Organ complications were uncommon (18.75%). Antibiotics were administered to 90% of patients and cure was achieved in all them. Compared with Q fever, patients with murine typhus more commonly had rash (p = 0.006) and thrombocytopenia (p < 0.001). CONCLUSION: Murine typhus is an emerging rickettsiosis in Tenerife and must be considered in the differential diagnosis with Q fever.
Subject(s)
Q Fever/diagnosis , Typhus, Endemic Flea-Borne/diagnosis , Typhus, Endemic Flea-Borne/epidemiology , Adolescent , Adult , Aged , Diagnosis, Differential , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , SpainABSTRACT
FUNDAMENTO Y OBJETIVO: El objetivo del estudio fue definir las características clínicas y epidemiológicas del tifus murino en la isla de Tenerife, Canarias. También se investigaron aspectos clínicos diferenciales con la fiebre Q. PACIENTES Y MÉTODO: Estudio prospectivo de los casos de tifus murino ingresados en un hospital de referencia en Tenerife durante el período 1998-2002. RESULTADOS: Se diagnosticó a 32 pacientes. La exposición a picaduras de pulga o ratas fue infrecuente (6,25 por ciento). La distribución mensual de los casos mostró un pico de incidencia en los meses de enero, agosto y septiembre, aunque no observamos una clara prevalencia estacional. La fiebre y la cefalea fueron los síntomas más frecuentes. El 28 por ciento de los pacientes presentó erupción cutánea. Los hallazgos de laboratorio más relevantes fueron la alteración enzimática hepática (88 por ciento) y la trombocitopenia (37,5 por ciento). El 18,75 por ciento de los casos presentó alguna complicación. Se administró tratamiento antibiótico al 90 por ciento de los pacientes. La evolución fue hacia la curación en todos los casos. Los pacientes con tifus murino presentaron con más frecuencia erupción cutánea (p = 0,006) y trombocitopenia (p < 0,001), comparados con los pacientes con fiebre Q. CONCLUSIÓN: El tifus murino es una rickettsiosis emergente en Tenerife y debe considerarse en el diagnóstico diferencial con la fiebre Q (AU)
Subject(s)
Middle Aged , Adult , Adolescent , Aged , Aged, 80 and over , Male , Female , Humans , Spain , Typhus, Endemic Flea-Borne , Incidence , Adverse Drug Reaction Reporting Systems , Prospective Studies , Q Fever , Diagnosis, Differential , Drug Therapy , Hospitalization , Health Services for the AgedABSTRACT
BACKGROUND: Our purpose was to evaluate the effectiveness of the nested polymerase chain reaction (nested-PCR) for the laboratory diagnosis of active toxoplasmosis in patients infected with human immunodeficiency virus (HIV). PATIENTS AND METHOD: The study was carried out in 157 HIV-infected patients. We determined IgG, IgM and IgA antibodies against Toxoplasma gondii as well as parasite DNA by nested-PCR in blood samples. RESULTS: IgG antibodies were detected in 56 patients, IgM in 1 and IgA in 5 patients. Eleven patients were found to have DNA of the parasite. CONCLUSIONS: The polymerase chain reaction is a rapid, sensitive and effective technique in the early diagnosis of toxoplasmosis in HIV-infected patients. Its positivity may also point to the beginning of treatment in asymptomatic individuals.
Subject(s)
Antibodies, Protozoan/blood , HIV Infections/blood , Polymerase Chain Reaction , Toxoplasma/immunology , Animals , HumansABSTRACT
FUNDAMENTO: El objetivo del trabajo es valorar la eficacia de la reacción en cadena de la polimerasa (PCR) anidada para el diagnóstico de laboratorio de la infección toxoplásmica activa en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). PACIENTES Y MÉTODO: Se realizó un estudio en 157 pacientes con infección por el VIH en quienes se investigó la presencia de anticuerpos anti Toxoplasma gondii IgG, IgM e IgA, así como de ADN de T. gondii mediante PCR anidada en muestras de sangre periférica. RESULTADOS: El estudio demostró la presencia de ADN del parásito en 11 pacientes, anticuerpos IgG anti-T. gondii en 56, del tipo IgM en uno y del tipo IgA en 5. CONCLUSIONES: La técnica de PCR anidada es una herramienta rápida, sensible y eficaz en el diagnóstico temprano de toxoplasmosis en pacientes con infección por el VIH, además de ser útil para la indicación del tratamiento en individuos asintomáticos (AU)
Subject(s)
Animals , Humans , Polymerase Chain Reaction , Toxoplasma , HIV Infections , Antibodies, ProtozoanABSTRACT
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