[Evaluation of the application of hyaluronic acid in postoperative arthroscopy patients with grade II-III gonarthrosis using the WOMAC scale]. / Evaluación en la aplicación de ácido hialurónico en pacientes postoperados de artroscopía con gonartrosis grado II-III mediante la escala de womac.

INTRODUCTION: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. OBJECTIVE: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. MATERIAL AND METHODS: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital "Dr. Darío Fernández Fierro". RESULTS: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. CONCLUSION: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant.

INTRODUCCIÓN: la gonartrosis es una enfermedad degenerativa, cuya pérdida de cartílago origina cambios en el hueso adyacente y su respuesta produce deformaciones e intentos de regeneración. En 1934 Meyer y Palmer aislaron el humor vítreo bovino, polisacárido denominado ácido hialurónico, que tiene la propiedad de visco elasticidad. Hoy en día se conocen múltiples procedimientos realizados en ortopedia, con la finalidad de limitar el proceso degenerativo que este conlleva. OBJETIVO: conocer el uso y la eficacia del ácido hialurónico, en el paciente que requiere artroscopía de rodilla, valorando la evolución del paciente mediante escala de WOMAC; así como el tiempo ideal de aplicación del ácido hialurónico en este grupo de estudio. MATERIAL Y MÉTODOS: ensayo clínico, no aleatorizado longitudinal, prospectivo, analítico. Se valoraron 48 pacientes de 45 a 60 años de edad, divididos en tres grupos con diagnóstico de gonartrosis grado II-III, en quienes se realizaron artroscopía con posterior aplicación ácido hialurónico; en el transquirúrgico (grupo 1), al mes del postquirúrgico (grupo 2) y sin aplicación (grupo 3) en un período de Septiembre de 2015 a Junio de 2016 en el Hospital del ISSSTE "Dr. Darío Fernández Fierro". RESULTADOS: el tratamiento mostró diferencias en los pacientes en cuanto a reducción de dolor y rigidez; y mejoría en capacidad funcional. CONCLUSIÓN: a pesar de que no es concluyente si algún tratamiento es mejor que otro, ciertos datos sugieren que el utilizar ácido hialurónico en el transquirúrgico mejora la rigidez y la función, sin embargo, no logró ser estadísticamente significativo.

Evaluación en la aplicación de ácido hialurónico en pacientes postoperados de artroscopía con gonartrosis grado II-III mediante la escala de WOMAC / Evaluation of the application of hyaluronic acid in postoperative arthroscopy patients with grade II-III gonarthrosis using the WOMAC scale

Resumen: Introducción: la gonartrosis es una enfermedad degenerativa, cuya pérdida de cartílago origina cambios en el hueso adyacente y su respuesta produce deformaciones e intentos de regeneración. En 1934 Meyer y Palmer aislaron el humor vítreo bovino, polisacárido denominado ácido hialurónico, que tiene la propiedad de visco elasticidad. Hoy en día se conocen múltiples procedimientos realizados en ortopedia, con la finalidad de limitar el proceso degenerativo que este conlleva. Objetivo: conocer el uso y la eficacia del ácido hialurónico, en el paciente que requiere artroscopía de rodilla, valorando la evolución del paciente mediante escala de WOMAC; así como el tiempo ideal de aplicación del ácido hialurónico en este grupo de estudio. Material y métodos: ensayo clínico, no aleatorizado longitudinal, prospectivo, analítico. Se valoraron 48 pacientes de 45 a 60 años de edad, divididos en tres grupos con diagnóstico de gonartrosis grado II-III, en quienes se realizaron artroscopía con posterior aplicación ácido hialurónico; en el transquirúrgico (grupo 1), al mes del postquirúrgico (grupo 2) y sin aplicación (grupo 3) en un período de Septiembre de 2015 a Junio de 2016 en el Hospital del ISSSTE «Dr. Darío Fernández Fierro¼. Resultados: el tratamiento mostró diferencias en los pacientes en cuanto a reducción de dolor y rigidez; y mejoría en capacidad funcional. Conclusión: a pesar de que no es concluyente si algún tratamiento es mejor que otro, ciertos datos sugieren que el utilizar ácido hialurónico en el transquirúrgico mejora la rigidez y la función, sin embargo, no logró ser estadísticamente significativo.

Abstract: Introduction: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. Objective: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. Material and methods: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital «Dr. Darío Fernández Fierro¼. Results: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. Conclusion: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant.

Methoprene treatment and its effect on male reproductive organ size and female remating in a fruit fly.

Methoprene, a juvenile hormone analog, is used to accelerate sexual maturation in males of species of economic importance in support to the sterile insect technique (SIT). In the SIT, mass-reared sterile males are released into the field and need to survive until they reach sexual maturation, find a wild female, mate with her and then induce female sexual refractoriness, so she will not remate with a wild counterpart. The use of methoprene shortens the time between release and copulation. However, in South American fruit flies, Anastrepha fraterculus, the ability of methoprene-treated males to inhibit female remating has been shown to be lower than wild males, when methoprene was applied by pupal immersion or topical application. Here we evaluated the possibility of incorporating methoprene into the male diet at different doses and the ability of those males to inhibit female remating, as well as the effect of methoprene on male reproductive organ size, due to the possible correlation between male accessory gland size and their content, and the role of male accessory gland proteins in female inhibition. We found that A. fraterculus males fed with methoprene in the adult protein diet at doses as high as 1% were less likely to inhibit female remating, however, at all other lower doses males had the same ability as untreated males to inhibit female remating. Males fed with methoprene had bigger male accessory glands and testes compared to methoprene-deprived males. We demonstrate that the incorporation of methoprene in adult male diets is possible in this species and potentially useful as a post-teneral, pre-release supplement at doses as low as 0.01%. Even at higher doses, the percentage of females remating after 48 h from the first copulation is sufficiently low in this species so as not compromise the efficiency of the SIT.

[What risk factors are associated with mortality and readmissions in osteoporotic hip fracture?] / ¿Qué factores de riesgo se asocian con la mortalidad y los reingresos en la fractura de cadera osteoporótica?

INTRODUCTION AND OBJECTIVE: Hip fracture in the elderly leads to long hospital stays, readmissions and mortality. OBJECTIVE: To identify risk factors associated with mortality and readmissions in elderly with hip fracture. PATIENTS AND METHODS: Prospective observational study in people over 65years with hip fracture between October-2017 and November-2018, followed for 12months (128 patients). STATISTICAL ANALYSIS: SPSS vs27.0. RESULTS: 6 (4.7%) patients were readmitted at 1 month; at year 24 (19.4%); 55 (44.4%) consulted for emergencies; 4 (3.1%) died during admission, and 26 (20.3%) in 12months; hospital stay 6.5 (SD: 4.80) days. Those with a previous Barthel less than 85 (6 [8.5%] vs 0 [0%]; P=.037) and less EuroQol5D (6 [10.0] vs 0 [0%]; P=.011) were readmitted more at one month. Those taking anticoagulants (OR: 3.33 (1.13-9.81); P=.003) and those with high surgical risk (18 [23.4%] vs 1 [5.6%]) were readmitted more after one year; P=.038). There was higher intra-episode mortality with renal failure (OR: 34.2 [3.25-359.93]; P=.003) and decompensated heart failure (OR: 23.8 [2.76-205.25]; P=.015). Higher mortality at one year in those older than 85years (OR: 4.3 [1.48-12.49]; P=.007); in those taking benzodiazepines (OR: 2.86 [1.06-7.73]; P=.038); if Barthel was less than 85 (OR: 2.96 [1.1-7.99]; P=.027) and if EuroQol5D was low (0.249 vs 0.547; P=.025). Those operated after 72h (24 [57.1%] vs. 29 [38.2%]; P=.047) consulted more for the emergency department. CONCLUSIONS: Renal failure and cardiac decompensation increased intra-episode mortality. Older age, benzodiazepines, and previous low functionality and low EuroQol5D increased mortality at one year. They were readmitted more if higher surgical risk, previously anticoagulated and worse quality of life and functionality.

M1 Macrophage Polarization Prevails in Epstein-Barr Virus-Infected Children in an Immunoregulatory Environment.

Macrophages can be polarized toward a proinflammatory phenotype (M1) (CD68+) or to an anti-inflammatory one (M2) (CD163+). Polarization can be triggered by cytokines such as IFN-γ for M1, or IL-10 and TGF-ß, for M2. In the context of pediatric Epstein Barr virus (EBV) infection, little is known about macrophage polarization in EBV primary or persistent infection. When studying tonsils of patients undergoing primary infection (PI), healthy carrier (HC), reactivation (R), and not infected (NI), M1 profile prevailed in all infection status. However, an increase in M2 cells was observed in those patients with broader expression of latency antigens, in particular EBNA2. Tonsils from primary infected patients showed an increased IL-10 expression, whereas, unexpectedly, TGF-ß expression correlated with M1 marker. Furthermore, an inverse correlation was demonstrated between CD68 and IFN-γ. Therefore, in the context of asymptomatic infection in children, M1 macrophage polarization prevails, even in the presence of IL-10 and TGF-Ꞵ immunomodulatory cytokines, and it might be independent from lymphomagenesis process. Our finding indicates that macrophages may have a significant plasticity in response to different types of extrinsic stimuli, and further studies are required to investigate M1 polarization under anti-inflammatory stimuli. IMPORTANCE Most studies on Epstein Barr virus (EBV) primary infection have been performed in adolescents and young adult populations with Infectious Mononucleosis (IM) in developed countries. Furthermore, studies related to macrophage polarization were assessed in EBV-associated lymphomas, but little is known about macrophage polarization in the context of primary infection at the site of viral entry and replication, the tonsils. Therefore, the aim of this study was to characterize macrophage response in children undergoing EBV primary or persistent infection, in order to enlighten the role of macrophages in viral pathogenesis, in a population with a high incidence of EBV-associated lymphomas in children younger than 10 years old. This study may contribute to explain, at least in part, the asymptomatic viral infection in children from an underdeveloped region, given that M1 polarization pattern prevails, but in a regulatory environment.

Vagus nerve neuropathy related to SARS COV-2 infection.

A 38-year-old woman with confirmed SARS-CoV-2 infection developed dysphagia to both solids and liquids. A fiberoptic nasolaryngoscopy and a videofluoroscopy swallowing study showed right vocal cord paresis, tenth cranial nerve neuropathy, as well as oral, hypopharynx, and supraglottic hypoesthesia. Orotracheal intubation was not required. The patient was fully recovered after undergoing a multidisciplinary rehabilitation program that included speech and deglutition therapy.

Life history, dormancy regulation, reproductive physiology and basic behaviour of the subtropical fruit fly Rhagoletotrypeta pastranai (Diptera:Tephritidae).

With the purpose of broadening knowledge on the evolution of life history strategies and behaviour of fruit flies within the tribe Carpomyini, the natural history and mating behaviour of the poorly known species Rhagoletotrypeta pastranai Aczél, are described for the first time. Larvae of R. pastranai were recovered from infested Celtis tala Gillies ex Planch and Celtis iguanaea (Jacq.) Sarg. during a 2-month fruiting period. Adults emerged from the recovered pupae after an average of 144.9 ± 3.9 days for females and 143.2 ± 3.38 days for males, suggesting that most individuals became dormant. Results of a variable winter length study suggested that environmental factors other than winter length may regulate dormancy/diapause duration in this subtropical species. Under laboratory conditions, R. pastranai adults lived an average of 51.13 ± 3.06 days in case of females and 48.08 ± 3.76 days in case of males, and required 5-15 days to reach sexual maturity. Behavioural observations under confinement revealed scarce sexual activity but sufficed to determine that, as in other members of the tribe Carpomyini, R. pastranai exhibits a male resource defence mating system. We discuss our findings emphasizing the importance of documenting the natural history and behaviour of unknown species of family Tephritidae and additionally, we highlight the necessity of future research to understand factors regulating dormancy/diapause and the evolution of life history strategies and sexual behaviour of subtropical species.

Irradiation dose does not affect male reproductive organ size, sperm storage, and female remating propensity in Ceratitis capitata.

The Mediterranean fruit fly Ceratitis capitata is a globally invasive pest, often controlled with the sterile insect technique (SIT). For the SIT, mass-rearing of the target insect followed by irradiation are imperatives. Sterile males are often less able to inhibit female remating and transfer less number of sperm, and even irradiation could affect male reproductive organs, with consequences for their ability to inhibit female remating. On the other hand, male age could affect their ability to modulate female response after mating. Here, we evaluated the quality of the genetic sexing strain Vienna-8-tsl mass-reared in Bioplanta San Juan, Argentina, under laboratory conditions, with regard to: (i) the ability of sterile males irradiated at 100 or 140 Gy to inhibit female remating, in the same day and at 24 h of first copulation; (ii) the ability of 3, 4 or 5 day-old sterile males to inhibit female remating at 24 h of first copulation, and (iii) the effect of a reduction in irradiation doses on the number of sperm stored by females and reproductive organ size in virgin males. Sterile males were better able than wild males to inhibit female remating in the same day of first copulation and as able as wild males 1 day after first copulation. Male age did not affect their ability to inhibit female receptivity. Number of sperm stored by females, testes size and ectodermal accessory glands size were not affected by male identity, while sterile 100 Gy males had larger mesodermal accessory glands than control lab males. A reduction in irradiation dose does not impact any variable measured, except for percentage of sperm-depleted females: females mated with sterile 100 Gy males had lower probabilities to store sperm. The results showed here are very encouraging for tsl Vienna 8 strain reared in Argentina and are discussed in comparison with previous studies in C. capitata female remating with dissimilar results.

Distinctive EBV infection characteristics in children from a developing country.

BACKGROUND: In developing countries, Epstein-Barr virus (EBV) infection is mostly asymptomatic in early childhood. EBV persistence may lead to different malignancies, such as B cell derived lymphomas. In Argentina, most children are seropositive at three years and an increased association between EBV and lymphoma was proved in children under 10 years old by our group. OBJECTIVE: Our aim was to characterize EBV infection at the site of entry and reactivation of viral infection -the tonsils- in order to better understand the mechanism of viral persistence in pediatric patients. METHODS: A cohort of 54 patients was described. We assessed specific antibodies profiles in sera; viral proteins presence by IHC on FFPE samples and EBV type from fresh tissue. RESULTS: EBV type 1 was prevalent, mostly in the youngest patients. Asymptomatic primary infected patients presented higher viral loads and Latency 0/I or II patterns, whereas the Latency III pattern was observed mostly in healthy carriers. There were no differences between groups in the expression of viral lytic antigens. This study discloses new features in patients undergoing primary infection from a developing population. Low viral inoculum and restricted viral antigen expression may be responsible for the lack of symptoms in children from our country.

New ecosystems in the deep subsurface follow the flow of water driven by geological activity.

Eukarya have been discovered in the deep subsurface at several locations in South Africa, but how organisms reach the subsurface remains unknown. We studied river-subsurface fissure water systems and identified Eukarya from a river that are genetically identical for 18S rDNA. To further confirm that these are identical species one metazoan species recovered from the overlying river interbred successfully with specimen recovered from an underlying mine at -1.4 km. In situ seismic simulation experiments were carried out and show seismic activity to be a major force increasing the hydraulic conductivity in faults allowing organisms to create ecosystems in the deep subsurface. As seismic activity is a non-selective force we recovered specimen of algae and Insecta that defy any obvious other explanation at a depth of -3.4 km. Our results show there is a steady flow of surface organisms to the deep subsurface where some survive and adapt and others perish. As seismic activity is also present on other planets and moons in our solar system the mechanism elucidated here may be relevant for future search and selection of landing sites in planetary exploration.

[Prevalence of osteoporosis and osteopenia in patients occupationally active]. / Prevalencia de osteoporosis y osteopenia en pacientes laboralmente activos.

BACKGROUND: Osteoporosis is a public health problem worldwide, affecting more than 200 million people. It is estimated that 30 to 50% of postmenopausal women suffer from it. According to the International Osteoporosis Foundation (IOF), osteoporosis is a disease characterized by a decrease in the density and quality of bones. The objective of this work was to know the prevalence of osteoporosis and osteopenia in healthy active workers. METHODS: Retrospective, observational study with active male and female workers in whom bone mineral density was evaluated by dual X-ray absorptiometry (DXA) of the hip and spine. The evaluation time was from June 2009 to June 2010. RESULTS: A total of 1,431 patients were recruited: 258 (18%) men and 1,173 (82%) women. According to the international parameters, the diagnoses of the central densitometries were, overall: 572 normal subjects (40%), 601 (42%) with osteopenia and 258 (18%) with osteoporosis. DISCUSSION: The results show that degenerative alterations in patients with osteoporosis or osteopenia are frequent, even among young people.

ANTECEDENTES: La osteoporosis constituye un problema de salud pública a nivel mundial; afecta a más de 200 millones de personas. Se calcula que de 30 a 50% de las mujeres postmenopáusicas la padecen. De acuerdo con la International Osteoporosis Foundation (IOF), la osteoporosis es una enfermedad que se distingue por la disminución de la densidad y calidad de los huesos. El objetivo de este trabajo fue conocer la prevalencia de osteoporosis y osteopenia en trabajadores activos sanos. MÉTODOS: Estudio retrospectivo observacional con trabajadores activos de sexo masculino y femenino en quienes se evaluó la densidad mineral ósea por absorciometría dual de rayos X (DXA) central de cadera y columna. El tiempo de evaluación fue de Junio de 2009 a Junio de 2010. RESULTADOS: Se reclutaron 1,431 pacientes: 258 (18%) hombres y 1,173 (82%) mujeres. De acuerdo con los parámetros internacionales, los diagnósticos de las densitometrías centrales fueron, de manera global: normales, 572 sujetos (40%); con osteopenia, 601 (42%); con osteoporosis, 258 (18%). DISCUSIÓN: Los resultados demuestran que las alteraciones degenerativas en pacientes con osteoporosis u osteopenia son frecuentes, incluso entre personas jóvenes.

[Frequency of complications in patients older than 60 years with hip fracture]. / Frecuencia de complicaciones en pacientes mayores de 60 años con fractura de cadera.

INTRODUCTION: According to figures from INEGI 2009, indicate that one in 12 Mexican women and one in 20 men over 65 will suffer a hip fracture. Is expected to reach 110,055 patients in the year 2050. Femoral neck stress fractures are more common in women and consist of 5 to 10%. There is a high number of patients with hip fracture complications, secondary to multiple factors which have been little studied and this limits its prevention. MATERIAL AND METHODS: A retrospective, observational and transversal study in senior citizens between January and December 2016 with hip fracture was conducted. Through collection of demographic data: age, sex, address, as well as type of fracture, type of management, primary diagnosis: ICD 10 S72 fracture of hip, hospital stay, surgery carried out and place of destination subsequent to discharge from the unit. RESULTS: The most affected gender was female. Within the main complications it correlates with delirium considering the average hospital stay of one day thrown outcomes, says that hospital stays are relatively short compared to other types of fractures. As in the international literature, the Transtrochanteric fracture is the main type of fracture; However in terms of surgical management of higher prevalence was hemiarthroplasty type Thompson followed by closed reduction internal fixation with DHS system placement.

INTRODUCCIÓN: Según indican las cifras del INEGI 2009, una de cada 12 mujeres mexicanas y uno de cada 20 hombres mayores de 65 años sufre una fractura de cadera. Se estima que en el año 2050 ésta alcance 110,055 pacientes. Las fracturas por estrés del cuello femoral son más frecuentes en mujeres y comprenden de 5 a 10%. Existe un alto número de pacientes con complicaciones de fractura de cadera secundario a múltiples factores, los cuales poco se han estudiado y esto limita su prevención. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, observacional y transversal de los pacientes de la tercera edad con fractura de cadera entre Enero y Diciembre de 2016 mediante recopilación de datos sociodemográficos: edad, sexo, dirección, además de tipo de fractura, tipo de manejo, diagnóstico principal: CIE 10 S72 fractura de cadera, procedimiento realizado, días de estancia intrahospitalaria, intervención quirúrgica realizada y lugar de destino posterior al alta de la unidad. RESULTADOS: El género más afectado fue el femenino. Las principales complicaciones se correlacionan con delirium, considerando el promedio de estancia hospitalaria de un día por los resultados arrojados, se afirma que las estancias hospitalarias son relativamente cortas en comparación con otro tipo de fracturas. Al igual que en la literatura internacional, la fractura transtrocantérica es el principal tipo de fractura; sin embargo, en cuanto al manejo quirúrgico el de mayor prevalencia fue la hemiartroplastía tipo Thompson seguido de reducción cerrada y fijación interna con colocación de sistema DHS.

Prevalencia de osteoporosis y osteopenia en pacientes laboralmente activos / Prevalence of osteoporosis and osteopenia in patients occupationally active

Resumen: Antecedentes: La osteoporosis constituye un problema de salud pública a nivel mundial; afecta a más de 200 millones de personas. Se calcula que de 30 a 50% de las mujeres postmenopáusicas la padecen. De acuerdo con la International Osteoporosis Foundation (IOF), la osteoporosis es una enfermedad que se distingue por la disminución de la densidad y calidad de los huesos. El objetivo de este trabajo fue conocer la prevalencia de osteoporosis y osteopenia en trabajadores activos sanos. Métodos: Estudio retrospectivo observacional con trabajadores activos de sexo masculino y femenino en quienes se evaluó la densidad mineral ósea por absorciometría dual de rayos X (DXA) central de cadera y columna. El tiempo de evaluación fue de Junio de 2009 a Junio de 2010. Resultados: Se reclutaron 1,431 pacientes: 258 (18%) hombres y 1,173 (82%) mujeres. De acuerdo con los parámetros internacionales, los diagnósticos de las densitometrías centrales fueron, de manera global: normales, 572 sujetos (40%); con osteopenia, 601 (42%); con osteoporosis, 258 (18%). Discusión: Los resultados demuestran que las alteraciones degenerativas en pacientes con osteoporosis u osteopenia son frecuentes, incluso entre personas jóvenes.

Abstract: Background: Osteoporosis is a public health problem worldwide, affecting more than 200 million people. It is estimated that 30 to 50% of postmenopausal women suffer from it. According to the International Osteoporosis Foundation (IOF), osteoporosis is a disease characterized by a decrease in the density and quality of bones. The objective of this work was to know the prevalence of osteoporosis and osteopenia in healthy active workers. Methods: Retrospective, observational study with active male and female workers in whom bone mineral density was evaluated by dual X-ray absorptiometry (DXA) of the hip and spine. The evaluation time was from June 2009 to June 2010. Results: A total of 1,431 patients were recruited: 258 (18%) men and 1,173 (82%) women. According to the international parameters, the diagnoses of the central densitometries were, overall: 572 normal subjects (40%), 601 (42%) with osteopenia and 258 (18%) with osteoporosis. Discussion: The results show that degenerative alterations in patients with osteoporosis or osteopenia are frequent, even among young people.

Frecuencia de complicaciones en pacientes mayores de 60 años con fractura de cadera / Frequency of complications in patients older than 60 years with hip fracture

Resumen: Introducción: Según indican las cifras del INEGI 2009, una de cada 12 mujeres mexicanas y uno de cada 20 hombres mayores de 65 años sufre una fractura de cadera. Se estima que en el año 2050 ésta alcance 110,055 pacientes. Las fracturas por estrés del cuello femoral son más frecuentes en mujeres y comprenden de 5 a 10%. Existe un alto número de pacientes con complicaciones de fractura de cadera secundario a múltiples factores, los cuales poco se han estudiado y esto limita su prevención. Material y métodos: Se realizó un estudio retrospectivo, observacional y transversal de los pacientes de la tercera edad con fractura de cadera entre Enero y Diciembre de 2016 mediante recopilación de datos sociodemográficos: edad, sexo, dirección, además de tipo de fractura, tipo de manejo, diagnóstico principal: CIE 10 S72 fractura de cadera, procedimiento realizado, días de estancia intrahospitalaria, intervención quirúrgica realizada y lugar de destino posterior al alta de la unidad. Resultados: El género más afectado fue el femenino. Las principales complicaciones se correlacionan con delirium, considerando el promedio de estancia hospitalaria de un día por los resultados arrojados, se afirma que las estancias hospitalarias son relativamente cortas en comparación con otro tipo de fracturas. Al igual que en la literatura internacional, la fractura transtrocantérica es el principal tipo de fractura; sin embargo, en cuanto al manejo quirúrgico el de mayor prevalencia fue la hemiartroplastía tipo Thompson seguido de reducción cerrada y fijación interna con colocación de sistema DHS.

Abstract: Introduction: According to Figures from INEGI 2009, indicate that one in 12 Mexican women and one in 20 men over 65 will suffer a hip fracture. Is expected to reach 110,055 patients in the year 2050. Femoral neck stress fractures are more common in women and consist of 5 to 10%. There is a high number of patients with hip fracture complications, secondary to multiple factors which have been little studied and this limits its prevention. Material and methods: A retrospective, observational and transversal study in senior citizens between January and December 2016 with hip fracture was conducted. Through collection of demographic data: age, sex, address, as well as type of fracture, type of management, primary diagnosis: ICD 10 S72 fracture of hip, hospital stay, surgery carried out and place of destination subsequent to discharge from the unit. Results: The most affected gender was female. Within the main complications it correlates with delirium considering the average hospital stay of one day thrown outcomes, says that hospital stays are relatively short compared to other types of fractures. As in the international literature, the Transtrochanteric fracture is the main type of fracture; However in terms of surgical management of higher prevalence was hemiarthroplasty type Thompson followed by closed reduction internal fixation with DHS system placement.

Modelos de atención al paciente pluripatológico / Care models for polypathological patients

Los pacientes pluripatológicos tienen unas características clínicas, funcionales, psicoafectivas, sociofamiliares y espirituales específicas. Son generalmente de edad avanzada, frágiles, con frecuentes descompensaciones, uso frecuente de recursos sanitarios, deterioro funcional importante y un elevado índice de dependencia; de lo que se deriva un importante impacto social, mortalidad elevada y consumo de recursos. Los modelos asistenciales actuales no han dado respuesta a estas necesidades, lo que produce problemas en la accesibilidad a los servicios sanitarios, descoordinación entre estos, mayor probabilidad de eventos adversos relacionados con la polimedicación y un alto consumo de recursos. En la última década, los modelos asistenciales están cambiando y se caracterizan por el trabajo en equipo multidisciplinar e interniveles, el autocuidado del paciente, la disponibilidad de herramientas para la toma de decisiones, los sistemas de información y comunicación y la prevención. Se pretende conseguir un equipo de salud preparado y proactivo y una población de pacientes informados y activados. La evaluación de los resultados en salud, procesos y costes de estos programas, se apoya todavía en evidencias moderadas o bajas. Por ello, no es fácil determinar el tipo e intensidad de las intervenciones, ni los grupos de pacientes sobre los que pueden aportar más beneficios (AU)

Polypathological patients have specific clinical, functional, psychoaffective, social, family and spiritual characteristics. These patients are generally elderly and frail and have frequent decompensations. They frequently use healthcare resources, have significant functional impairment and have a high index of dependence. This results in a significant social impact, high mortality and a high consumption of resources. The current healthcare models have not answered these needs, which causes problems with accessibility to healthcare services, a lack of coordination among these services, a higher probability of adverse events related to polypharmacy and a high consumption of resources. In the past decade, the healthcare models have changed and are characterized by work in multidisciplinary and interlevel teams, patient self-care, the availability of tools for decision making, information and communication systems and prevention. The goal is to have prepared and proactive health teams and an informed and active patient population. The assessment of health results, processes and the costs for these programs is still based on moderate to low evidence. It is therefore not an easy task to determine the type and intensity of interventions or to determine the patient groups that could gain more benefits (AU)

Care models for polypathological patients. / Modelos de atención al paciente pluripatológico.

Polypathological patients have specific clinical, functional, psychoaffective, social, family and spiritual characteristics. These patients are generally elderly and frail and have frequent decompensations. They frequently use healthcare resources, have significant functional impairment and have a high index of dependence. This results in a significant social impact, high mortality and a high consumption of resources. The current healthcare models have not answered these needs, which causes problems with accessibility to healthcare services, a lack of coordination among these services, a higher probability of adverse events related to polypharmacy and a high consumption of resources. In the past decade, the healthcare models have changed and are characterized by work in multidisciplinary and interlevel teams, patient self-care, the availability of tools for decision making, information and communication systems and prevention. The goal is to have prepared and proactive health teams and an informed and active patient population. The assessment of health results, processes and the costs for these programs is still based on moderate to low evidence. It is therefore not an easy task to determine the type and intensity of interventions or to determine the patient groups that could gain more benefits.

Validation of PROFUND prognostic index over a four-year follow-up period.

BACKGROUND/OBJECTIVES: The PROFUND index stratifies accurately the 12-month mortality risk of polypathological patients (PPs), but its fitness over a longer follow-up period remains unknown. We aimed to explore the calibration and discrimination power of PROFUND index over 4-years, in order to assess its follow-up interval generalizability. DESIGN: Multicenter prospective cohort-study. SETTING: 33 Spanish hospitals. PARTICIPANTS: PPs included after hospital discharge, outpatient clinics, or home hospitalization. MEASUREMENTS: Mortality over a 4-year follow-up period. METHODS: PROFUND index calibration was assessed by risk-quartiles predicted/observed mortality (Hosmer-Lemeshow goodness-of-fit test), and its discrimination power by ROC curves. RESULTS: A total of 768 patients were included (630 [82%] of them completed the 4-year follow-up). Global mortality rate was 63.5%. When assessing individual patient scores, mortality was 52% in the lowest risk group (0-2 points in PROFUND score); 73.5% in the low-intermediate risk group (3-6 points), 85% in the intermediate-high group (7-10 points); and 92% in the highest risk group (≥11 points). Accuracy testing of the PROFUND index showed good calibration (P=.8 in the Hosmer-Lemeshow goodness-of-fit test), and also a good discrimination power (AUC=0.71 [0.67-0.77] in ROC curve). CONCLUSIONS: The PROFUND index maintained its accuracy in predicting mortality of polypathological patients over a 4-year follow-up period. This index may be of potential usefulness in deciding the most appropriate health-care interventions in populations with multimorbidity.

Inappropriate prescribing in elderly people with diabetes admitted to hospital.

AIMS: To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS: In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS: Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS: Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.