The impact of common co-morbidities (as measured using the Charlson index) on hip fracture risk in elderly men: a population-based cohort study.

UNLABELLED: We used a large population-based health care database to determine the impact of common co-morbidities on hip fracture risk amongst elderly men. We demonstrated that diabetes, chronic obstructive pulmonary disease, renal failure, HIV infection, dementia, and cerebrovascular disease are independent predictors of hip fracture, as is a Charlson score of ≥ 3. INTRODUCTION: Risk factors for hip fractures in men are still unclear. We aimed to identify common co-morbidities (amongst those in the Charlson index) that confer an increased risk of hip fracture amongst elderly men. METHODS: We conducted a population-based cohort study using data from the SIDIAP (Q) database. SIDIAP(Q) contains primary care and hospital inpatient records of a representative 30% of the population of Catalonia, Spain (>2 million people). All men aged ≥ 65 years registered on 1 January 2007 were followed up until 31 December 2009. Both exposure (co-morbidities in the Charlson index) and outcome (incident hip fractures) were ascertained using ICD codes. Poisson regression models were fitted to estimate the effect of (1) each individual co-morbidity and (2) the composite Charlson index score, on hip fracture risk, after adjustment for age, body mass index, smoking, alcohol drinking, and use of oral glucocorticoids. RESULTS: We observed 186,171 men for a median (inter-quartile range) of 2.99 (2.37-2.99) years. In this time, 1,718 (0.92%) participants had a hip fracture. The following co-morbidities were independently associated with hip fractures: diabetes mellitus, chronic obstructive pulmonary disease (COPD), renal failure, HIV infection, dementia, and cerebrovascular disease. A Charlson score of ≥ 3 conferred an increased hip fracture risk. CONCLUSION: Common co-morbidities including diabetes, COPD, cerebrovascular disease, renal failure, and HIV infection are independently associated with an increased risk of hip fracture in elderly men. A Charlson score of 3 or more is associated with a 50% higher risk of hip fracture in this population.

Influence of solar irradiation on vitamin D levels in children on anticonvulsant drugs.

Previous studies about the serum levels of vitamin D metabolites in epileptic patients have given conflicting results. We have investigated the influence of chronic anti-epileptic treatment on mineral metabolism in 17 ambulatory epileptic children who were studied for 2 seasons with high and low levels of solar radiation, respectively. No differences in serum calcium, phosphate or 1.25-dihydroxyvitamin D were observed between patients and control children. Patients also had normal levels of 25-hydroxyvitamin D [25(OH)D] in summer. However, serum 25(OH)D concentrations were lower in patients than in controls in winter months (12.6 +/- 1.4 versus 19.6 +/- 1.2 ng/ml, P less than 0.001). These findings point out the influence of the intensity of solar irradiation, and subsequently of vitamin D availability, on the effect of anticonvulsant drugs on vitamin D metabolism, and may help to explain the conflicting results of previous reports. Prophylactic vitamin D therapy should be considered when climatic conditions or patients' life styles do not allow an adequate exposure to sunlight.

False aneurysm formation after Salmonella virchow infection of a pre-existent ventricular aneurysm--survival after surgical resection.

A 55 year old man with a left ventricular aneurysm, secondary to a previous myocardial infarction, was hospitalized due to a Salmonella virchow bacteraemia. During a 3-week hospital course he was persistently bacteraemic and febrile despite antibiotic treatment. Gallium isotope scanning and 2-D-echocardiography were helpful in demonstrating the presence of an infected false aneurysm at the site of a true aneurysm. Surgical resection in addition to prolonged antibiotic therapy was necessary for cure.

Naproxen disposition in hepatic and biliary disorders.

The pharmacokinetics of Naproxen have been studied in 11 patients diagnosed with various hepatic and biliary disorders after oral administration of a single dose of 250 mg of the drug. The drug is seen to follow an open two-compartment model. In relation to the values obtained from healthy volunteers, it may be seen that in these patients there are modifications in the absorption, distribution and elimination of the drug. In certain of the patients with cholestasis, a significant delay in absorption may be observed. In most of the patients studied, elimination is clearly diminished due to a decrease in the capacity to biotransform the drug within the organism. In healthy volunteers, the plasma half-life of the beta-phase has an average value of 14.14 hrs while in patients it reaches a value of 20.36 hrs.

Influence of hepatic and renal disorders on the pharmacokinetics of sulfachloropyridacine.

The pharmacokinetics of sulfachloropyridacine were studied in a series of 30 adult patients (healthy volunteers, patients with moderate hepatic impairment and patients with renal impairment). In all cases a 500 mg dose of sodium sulfachloropyridacine was administered orally. The drug follows a single compartment pharmacokinetic model. In healthy patients the following pharmacokinetic parameters were established: Ka = 5.130 h-1, Ke = 0.205 h-1, tmax = 40 min, Vd = 7.94 liters, and in patients diagnosed with cirrhosis a decrease is appreciable in the absorption constant and in the area below the blood-time levels curve. A linear relationship is established between the elimination constant and creatinine clearance. A dosage regimen, applicable to patients with renal impairment, is established as a function of the pharmacokinetic parameters. The degree of plasma protein binding of sulfachloropyridacine diminishes significantly in patients with renal impairment.

The influence of ascites on the pharmacokinetics of amikacin.

The pharmacokinetics of Amikacin are studied after the administration of 7.5 mg/kg body weight to 10 ascitic patients diagnosed with various hepatic disorders. The antibiotic was determined microbiologically in plasma and in the ascitic fluid. The antibiotic follows a two-compartment kinetic model, and it may be seen that once the rapid disposition phase has ended, an inflexion in the plasma-time levels curve takes place, with a passing increase in the plasma concentrations. From the pharmacokinetic study of Amikacin in these patients, it may be deduced that the ascitic liquid forms part of the central compartment for the effects of distribution, though not for the effects of elimination. The plasma half-life of the slow disposition phase is analogous to that obtained from non-ascitic patients with normal renal function. In one of the patients, the antibiotic was administered intraperitoneally; following this, the plasma concentrations of Amikacin were detected. In the last of the 10 patients included in the survey, the evolution of the plasma concentrations of the antibiotic were studied while the patient was undergoing a multiple dosage regimen with the aim of determining the accumulation of Amikacin in the ascitic fluid. A dosage regimen of multiple doses is programmed which should guarantee the efficiency and safety of the antibiotic.