Estudio piloto para determinar la asociación entre la microbiota intestinal y la fractura de cadera por fragilidad / Pilot study to determine the association between gut microbiota and fragility hip fracture

Introducción: Las fracturas de cadera son la causa más frecuente de ingreso hospitalario en los servicios de ortopedia de Europa y suponen un importante problema sanitario. Por ello, es de gran interés identificar factores de riesgo adicionales que nos ayuden a comprender mejor la fisiopatología de estas fracturas y a mejorar nuestra capacidad preventiva. Existen datos suficientes para apoyar la teoría de la modulación de la masa ósea por la microbiota intestinal (osteomicrobiología); sin embargo, faltan estudios clínicos en humanos que relacionen directamente la microbiota con el riesgo de fractura de cadera. Material y métodos: Estudio observacional, analítico, de casos y controles. La muestra consta de 50 pacientes y se distribuye de la siguiente manera: 25 pacientes ancianos con fractura de cadera por fragilidad y 25 controles sanos sin fractura. Se analizó la microbiota intestinal mediante extracción de ADN de muestras de heces y secuenciación del ADN ribosómico 16S tras la generación de bibliotecas de genes. Resultados: La diversidad alfa reveló una elevación de los estimadores para el nivel taxonómico de clase en el grupo de fracturas de cadera. Los órdenes Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales y Enterobacterales fueron los órdenes dominantes en ambos grupos. En los pacientes con fractura, se observó un aumento porcentual significativo del orden de Bacteroidales (p<0,001) y Peptostreptococcales-Tissierellales (p<0,005), así como una disminución de las del orden Lachnospirales (p<0,001) respecto a los controles. Conclusiones:Este estudio ha encontrado una asociación entre una microbiota específica en pacientes ancianos con fractura de cadera por fragilidad. Estos hallazgos abren la puerta a nuevas estrategias para prevenir las fracturas de cadera. Es posible que la modificación de la microbiota mediante probióticos se revele como un método eficaz para reducir el riesgo de fractura de cadera.(AU)

Introduction: Hip fractures are the most common cause of hospital admission to orthopaedic departments in Europe and they generate a major health problem. Therefore, it is of great interest to identify additional risk factors that will help us to better understand the pathophysiology of these fractures and improve our preventive capacity. There is sufficient data to support the theory of modulation of bone mass by gut microbiota (osteomicrobiology); however, there is a lack of human clinical studies directly linking microbiota to hip fracture risk. Material and methods: Observational, analytical, case–control study. The sample consisted of 50 patients and it was distributed as follows: 25 elderly patients with fragility hip fracture and 25 subjects without fracture. The intestinal microbiota was determined by DNA extraction from stool samples and 16S ribosomal DNA sequencing after generation of gene libraries. Results: Alpha diversity revealed an elevation of the estimators for the taxonomic class level in the hip fracture group. The orders Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales and Enterobacterales were the dominant orders in both groups. In patients with fracture, a significant percentage increase in the orders Bacteroidales (p<.001) and Peptostreptococcales-Tissierellales (p<.005) was observed, as well as a decrease in the orders Lachnospirales (p<.001) compared to controls. Conclusions: This study has found an association between a specific microbiota in elderly patients with fragility hip fracture. These findings open the door to new strategies to prevent hip fractures. Modification of the microbiota through probiotics may prove to be an effective method to reduce the risk of hip fracture.(AU)

[Translated article] Pilot study to determine the association between gut microbiota and fragility hip fracture / Estudio piloto para determinar la asociación entre la microbiota intestinal y la fractura de cadera por fragilidad

Introducción: Las fracturas de cadera son la causa más frecuente de ingreso hospitalario en los servicios de ortopedia de Europa y suponen un importante problema sanitario. Por ello, es de gran interés identificar factores de riesgo adicionales que nos ayuden a comprender mejor la fisiopatología de estas fracturas y a mejorar nuestra capacidad preventiva. Existen datos suficientes para apoyar la teoría de la modulación de la masa ósea por la microbiota intestinal (osteomicrobiología); sin embargo, faltan estudios clínicos en humanos que relacionen directamente la microbiota con el riesgo de fractura de cadera. Material y métodos: Estudio observacional, analítico, de casos y controles. La muestra consta de 50 pacientes y se distribuye de la siguiente manera: 25 pacientes ancianos con fractura de cadera por fragilidad y 25 controles sanos sin fractura. Se analizó la microbiota intestinal mediante extracción de ADN de muestras de heces y secuenciación del ADN ribosómico 16S tras la generación de bibliotecas de genes. Resultados: La diversidad alfa reveló una elevación de los estimadores para el nivel taxonómico de clase en el grupo de fracturas de cadera. Los órdenes Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales y Enterobacterales fueron los órdenes dominantes en ambos grupos. En los pacientes con fractura, se observó un aumento porcentual significativo del orden de Bacteroidales (p<0,001) y Peptostreptococcales-Tissierellales (p<0,005), así como una disminución de las del orden Lachnospirales (p<0,001) respecto a los controles. Conclusiones:Este estudio ha encontrado una asociación entre una microbiota específica en pacientes ancianos con fractura de cadera por fragilidad. Estos hallazgos abren la puerta a nuevas estrategias para prevenir las fracturas de cadera. Es posible que la modificación de la microbiota mediante probióticos se revele como un método eficaz para reducir el riesgo de fractura de cadera.(AU)

Introduction: Hip fractures are the most common cause of hospital admission to orthopaedic departments in Europe and they generate a major health problem. Therefore, it is of great interest to identify additional risk factors that will help us to better understand the pathophysiology of these fractures and improve our preventive capacity. There is sufficient data to support the theory of modulation of bone mass by gut microbiota (osteomicrobiology); however, there is a lack of human clinical studies directly linking microbiota to hip fracture risk. Material and methods: Observational, analytical, case–control study. The sample consisted of 50 patients and it was distributed as follows: 25 elderly patients with fragility hip fracture and 25 subjects without fracture. The intestinal microbiota was determined by DNA extraction from stool samples and 16S ribosomal DNA sequencing after generation of gene libraries. Results: Alpha diversity revealed an elevation of the estimators for the taxonomic class level in the hip fracture group. The orders Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales and Enterobacterales were the dominant orders in both groups. In patients with fracture, a significant percentage increase in the orders Bacteroidales (p<.001) and Peptostreptococcales-Tissierellales (p<.005) was observed, as well as a decrease in the orders Lachnospirales (p<.001) compared to controls. Conclusions: This study has found an association between a specific microbiota in elderly patients with fragility hip fracture. These findings open the door to new strategies to prevent hip fractures. Modification of the microbiota through probiotics may prove to be an effective method to reduce the risk of hip fracture.(AU)

[Translated article] Pilot study to determine the association between gut microbiota and fragility hip fracture.

INTRODUCTION: Hip fractures are the most common cause of hospital admission to orthopaedic departments in Europe and they generate a major health problem. Therefore, it is of great interest to identify additional risk factors that will help us to better understand the pathophysiology of these fractures and improve our preventive capacity. There is sufficient data to support the theory of modulation of bone mass by gut microbiota (osteomicrobiology); however, there is a lack of human clinical studies directly linking microbiota to hip fracture risk. MATERIAL AND METHODS: Observational, analytical, case-control study. The sample consisted of 50 patients and it was distributed as follows: 25 elderly patients with fragility hip fracture and 25 subjects without fracture. The intestinal microbiota was determined by DNA extraction from stool samples and 16S ribosomal DNA sequencing after generation of gene libraries. RESULTS: Alpha diversity revealed an elevation of the estimators for the taxonomic class level in the hip fracture group. The orders Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales and Enterobacterales were the dominant orders in both groups. In patients with fracture, a significant percentage increase in the orders Bacteroidales (p<.001) and Peptostreptococcales-Tissierellales (p<.005) was observed, as well as a decrease in the orders Lachnospirales (p<.001) compared to controls. CONCLUSIONS: This study has found an association between a specific microbiota in elderly patients with fragility hip fracture. These findings open the door to new strategies to prevent hip fractures. Modification of the microbiota through probiotics may prove to be an effective method to reduce the risk of hip fracture.

Pilot study to determine the association between gut microbiota and fragility hip fracture. / Estudio piloto para determinar la asociación entre la microbiota intestinal y la fractura de cadera por fragilidad.

INTRODUCTION: Hip fractures are the most common cause of hospital admission to orthopaedic departments in Europe and they generate a major health problem. Therefore, it is of great interest to identify additional risk factors that will help us to better understand the pathophysiology of these fractures and improve our preventive capacity. There is sufficient data to support the theory of modulation of bone mass by gut microbiota (osteomicrobiology); however, there is a lack of human clinical studies directly linking microbiota to hip fracture risk. MATERIAL AND METHODS: Observational, analytical, case-control study. The sample consisted of 50 patients and it was distributed as follows: 25 elderly patients with fragility hip fracture and 25 subjects without fracture. The intestinal microbiota was determined by DNA extraction from stool samples and 16S ribosomal DNA sequencing after generation of gene libraries. RESULTS: Alpha diversity revealed an elevation of the estimators for the taxonomic class level in the hip fracture group. The orders Bacteroidales, Oscillospirales, Lachnospirales, Peptostreptococcales-Tissierellales and Enterobacterales were the dominant orders in both groups. In patients with fracture, a significant percentage increase in the orders Bacteroidales (p<.001) and Peptostreptococcales-Tissierellales (p<.005) was observed, as well as a decrease in the orders Lachnospirales (p<.001) compared to controls. CONCLUSIONS: This study has found an association between a specific microbiota in elderly patients with fragility hip fracture. These findings open the door to new strategies to prevent hip fractures. Modification of the microbiota through probiotics may prove to be an effective method to reduce the risk of hip fracture.

Aptitudes y conocimientos en medicina musculoesquelética en licenciados en medicina previos a su incorporación al sistema de residencia del Sistema Nacional de Salud / Skills and knowledge in musculoskeletal medicine in medical graduates prior to their incorporation into the residency system of the National Health System

Introducción: La enfermedad del sistema musculoesquelético es una causa frecuente de demanda asistencial. El conocimiento en medicina musculoesquelética (MME) debe ser esencial para gran parte de las especialidades. Desafortunadamente, gran parte de los médicos internos residentes (MIR) reconocen tener falta de confianza y de competencia en este campo. Material y métodos: Cincuenta MIR recién incorporados a su plaza (32 de ellos residentes de COT de la Comunidad Valenciana) completaron el test de competencia básica en MME de Freedman y Berstein. Además, realizaron un cuestionario sobre el grado de confianza a la hora de desempeñar 5 tareas habituales en la práctica clínica y sobre la percepción de la carga curricular de MME en su formación académica. Resultados: La puntuación media global obtenida en el test fue de 69,44% (SD 13,32%), mientras que la puntuación concreta para 5 preguntas que se consideraban «banderas rojas» fue de 14,34%(SD 2,58%). Ambas mostraron diferencias significativas entre los residentes de COT y otras especialidades.La mediana obtenida en la valoración del nivel de confianza en la exploración de heridas fue de 2 sobre 5 (IQR 2), con diferencias significativas (p=0,014) entre el grupo COT y el de otras especialidades. La percepción del tiempo dedicado en la facultad en materia de MME fue considerada como adecuada (mediana 3, IQR 1). El 64% modificaría el planteamiento de la parte práctica del currículo en MME. Conclusiones: La prueba global fue superada por el 50% de los residentes, lo cual pone de manifiesto que la enseñanza en MME es deficitaria durante el periodo universitario y formativo preMIR. Consideramos primordial la planificación de acciones formativas que se traduzca en un aumento de los conocimientos y aptitudes necesarias para su correcto manejo, ya que ello se traduciría en una mayor agilidad del sistema, una mejor asistencia sanitaria y un mejor cribado de derivaciones especializadas.(AU)

Introduction: Pathology of the musculoskeletal system is a frequent cause of healthcare requirements. Knowledge of musculoskeletal medicine (MSM) should be essential for most specialties. Unfortunately, many medical intern residents (MIRs) admit to a lack of confidence and competence in this field. Material and methods: 50 recently hired MIRs (32 of whom were COT residents from the Comunidad Valenciana) completed the Freedman and Berstein test of basic competency in MSM. In addition, they completed a questionnaire about their confidence in performing five common tasks in clinical practice and their perception of the curricular importance of medicine in their academic training. Results: The overall mean score obtained on the test was 69.44% (SD 13.32%), while the specific score for 5 “red flags” questions was 14.34% (SD 2.58%). Both of them showed significant differences between COT residents and other specialties.The median obtained in the evaluation of the level of confidence in wound examination was 2 above 5 (IQR 2), with significant differences (p=.014) between the COT group and other specialties. The perception of the time spent in the faculty on MSM was considered adequate (median 3, IQR 1). 64% of participants would modify the approach to the practical part of the curriculum in MME. Conclusions: The overall test was passed by 50% of the residents, which shows that the teaching of MME is deficient during the university and pre-MIR training period. We believe that it is important to plan training actions to increase the knowledge and skills necessary for its correct handling; this way, the system would be more efficient with better health care and a better screening of specialised derivations.(AU)

Skills and knowledge in musculoskeletal medicine in medical graduates prior to their incorporation into the residency system of the National Health System / Aptitudes y conocimientos en medicina musculoesquelética en licenciados en medicina previo a su incorporación al sistema de residencia del Sistema Nacional de Salud

Introduction: Pathology of the musculoskeletal system is a frequent cause of healthcare requirements. Knowledge of musculoskeletal medicine (MSM) should be essential for most specialties. Unfortunately, many medical intern residents (MIRs) admit to a lack of confidence and competence in this field. Material and methods: 50 recently hired MIRs (32 of whom were COT residents from the Comunidad Valenciana) completed the Freedman and Berstein test of basic competency in MSM. In addition, they completed a questionnaire about their confidence in performing five common tasks in clinical practice and their perception of the curricular importance of medicine in their academic training. Results: The overall mean score obtained on the test was 69.44% (SD 13.32%), while the specific score for 5 “red flags” questions was 14.34% (SD 2.58%). Both of them showed significant differences between COT residents and other specialties.The median obtained in the evaluation of the level of confidence in wound examination was 2 above 5 (IQR 2), with significant differences (p=.014) between the COT group and other specialties. The perception of the time spent in the faculty on MSM was considered adequate (median 3, IQR 1). 64% of participants would modify the approach to the practical part of the curriculum in MME. Conclusions: The overall test was passed by 50% of the residents, which shows that the teaching of MME is deficient during the university and pre-MIR training period. We believe that it is important to plan training actions to increase the knowledge and skills necessary for its correct handling; this way, the system would be more efficient with better health care and a better screening of specialised derivations.(AU)

Introducción: La enfermedad del sistema musculoesquelético es una causa frecuente de demanda asistencial. El conocimiento en medicina musculoesquelética (MME) debe ser esencial para gran parte de las especialidades. Desafortunadamente, gran parte de los médicos internos residentes (MIR) reconocen tener falta de confianza y de competencia en este campo. Material y métodos: Cincuenta MIR recién incorporados a su plaza (32 de ellos residentes de COT de la Comunidad Valenciana) completaron el test de competencia básica en MME de Freedman y Berstein. Además, realizaron un cuestionario sobre el grado de confianza a la hora de desempeñar 5 tareas habituales en la práctica clínica y sobre la percepción de la carga curricular de MME en su formación académica. Resultados: La puntuación media global obtenida en el test fue de 69,44% (SD 13,32%), mientras que la puntuación concreta para 5 preguntas que se consideraban «banderas rojas» fue de 14,34%(SD 2,58%). Ambas mostraron diferencias significativas entre los residentes de COT y otras especialidades.La mediana obtenida en la valoración del nivel de confianza en la exploración de heridas fue de 2 sobre 5 (IQR 2), con diferencias significativas (p=0,014) entre el grupo COT y el de otras especialidades. La percepción del tiempo dedicado en la facultad en materia de MME fue considerada como adecuada (mediana 3, IQR 1). El 64% modificaría el planteamiento de la parte práctica del currículo en MME. Conclusiones: La prueba global fue superada por el 50% de los residentes, lo cual pone de manifiesto que la enseñanza en MME es deficitaria durante el periodo universitario y formativo preMIR. Consideramos primordial la planificación de acciones formativas que se traduzca en un aumento de los conocimientos y aptitudes necesarias para su correcto manejo, ya que ello se traduciría en una mayor agilidad del sistema, una mejor asistencia sanitaria y un mejor cribado de derivaciones especializadas.(AU)

Hábitos alimentarios, conductas sedentarias y sobrepeso y obesidad en adolescentes de Barcelona / Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)

INTRODUCCIÓN: El desayuno representa la ingesta más importante de una alimentación equilibrada y su supresión se asocia al sobrepeso. El objetivo del estudio es estimar la prevalencia de sobrepeso y obesidad en adolescentes de Barcelona y analizar su asociación con hábitos alimentarios inadecuados y conductas sedentarias. MATERIAL Y MÉTODOS: Estudio transversal realizado en 2008 a una muestra representativa de estudiantes de secundaria de Barcelona. Se definió sobrepeso y obesidad en base al índice de masa corporal (IMC) a partir de medidas objetivas. Se determinó la prevalencia de sobrepeso y obesidad y se analizó su asociación con hábitos alimentarios, actividades sedentarias y actividad física mediante modelos de regresión logística. RESULTADOS: Se analizaron 3.089 escolares (52% chicas). La prevalencia de exceso de peso fue del 26,1% en chicos (6,2% obesidad) y del 20,6% en chicas (3,7% obesidad). En ambos sexos, el sobrepeso se asoció a una menor edad, menor frecuencia de desayunar, estar realizando una dieta para adelgazar y menor ingesta de alimentos menos saludables. Realizar dieta para adelgazar y una menor ingesta de alimentos menos saludables también se asociaron a la obesidad en ambos sexos. En chicos, además, la obesidad se asoció positivamente al sedentarismo. CONCLUSIONES: Los resultados reflejan la magnitud del sobrepeso y la obesidad como problema de salud pública y confirman la necesidad de la toma de desayuno para prevenir el exceso de peso. Además, permiten ampliar el conocimiento sobre los factores asociados al sobrepeso y obesidad para mejorar los programas de promoción de la salud en escolares ya existentes

INTRODUCTION: Breakfast is considered the most important meal of the day in an equilibrated diet. Skipping breakfast has been associated with overweight. This study aimed to describe overweight and obesity among high school students in Barcelona and to analyze their association with eating habits and sedentary behaviors. MATERIAL AND METHODS: A cross-sectional study was performed in 2008 on a representative sample of high-school students in Barcelona (Spain). Overweight and obesity were defined using Body Mass Index (BMI), which was calculated from objective measurements. The prevalences of overweight and obesity were determined, and their association with eating habits, sedentary behaviors, and physical activity was analyzed using logistic regression models. RESULTS: A total of 3,089 students were analyzed (52% girls). The prevalence of overweight was 26.1% in boys (6.2% obese) and 20.6% in girls (3.7% obese). In both sexes, overweight was associated with being younger, having breakfast less often, being on a diet, and with a lower frequency of unhealthy food intake. Being on a diet and a lower unhealthy food intake were related to obesity in both sexes. Among boys, obesity was also associated with sedentary behaviors. CONCLUSIONS: The results show that overweight and obesity are a serious public health problem and confirm the importance of breakfast to prevent overweight. Moreover, these results allow us to expand our knowledge on the factors associated with overweight and obesity in order to improve current school preventive programs

Caseinophosphopeptides released after tryptic hydrolysis versus simulated gastrointestinal digestion of a casein-derived by-product.

The production of caseinophosphopeptides from a casein-derived by-product generated during the manufacture of a functional ingredient based on antihypertensive peptides was attempted. The casein by-product was submitted to tryptic hydrolysis for 30, 60 and 120min and further precipitated with calcium chloride and ethanol at pH 4.0, 6.0 and 8.0. Identification and semi quantification of the derived products by tandem mass spectrometry revealed some qualitative and quantitative changes in the released caseinophosphopeptides over time at the different precipitation pHs. The by-product was also subjected to simulated gastrointestinal digestion. Comparison of the resulting peptides showed large sequence homology in the phosphopeptides released by tryptic hydrolysis and simulated gastrointestinal digestion. Some regions, specifically αS1-CN 43-59, αS1-CN 60-74, ß-CN 1-25 and ß-CN 30-50 showed resistance to both tryptic hydrolysis and simulated digestion. The results of the present study suggest that this casein-derived by-product can be used as a source of CPPs.

[Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. / Hábitos alimentarios, conductas sedentarias y sobrepeso y obesidad en adolescentes de Barcelona.

INTRODUCTION: Breakfast is considered the most important meal of the day in an equilibrated diet. Skipping breakfast has been associated with overweight. This study aimed to describe overweight and obesity among high school students in Barcelona and to analyze their association with eating habits and sedentary behaviors. MATERIAL AND METHODS: A cross-sectional study was performed in 2008 on a representative sample of high-school students in Barcelona (Spain). Overweight and obesity were defined using Body Mass Index (BMI), which was calculated from objective measurements. The prevalences of overweight and obesity were determined, and their association with eating habits, sedentary behaviors, and physical activity was analyzed using logistic regression models. RESULTS: A total of 3,089 students were analyzed (52% girls). The prevalence of overweight was 26.1% in boys (6.2% obese) and 20.6% in girls (3.7% obese). In both sexes, overweight was associated with being younger, having breakfast less often, being on a diet, and with a lower frequency of unhealthy food intake. Being on a diet and a lower unhealthy food intake were related to obesity in both sexes. Among boys, obesity was also associated with sedentary behaviors. CONCLUSIONS: The results show that overweight and obesity are a serious public health problem and confirm the importance of breakfast to prevent overweight. Moreover, these results allow us to expand our knowledge on the factors associated with overweight and obesity in order to improve current school preventive programs.

Functional bowel symptoms in quiescent inflammatory bowel diseases: role of epithelial barrier disruption and low-grade inflammation.

OBJECTIVE: To determine the role of colonic barrier defects and low-grade inflammation in irritable bowel syndrome (IBS)-like symptoms in quiescent inflammatory bowel disease (IBD). DESIGN: Caecal biopsies were collected from 51 IBS, 49 quiescent IBD (31 Crohn's disease (CD) and 18 ulcerative colitis (UC)) patients and 27 controls. IBS was assessed using the Rome III criteria and the IBS severity score. Epithelial barrier integrity was evaluated by determining the paracellular permeability of biopsies mounted in Ussing chambers and the mRNA expression of tight junction proteins (ZO-1, α-catenin and occludin). Low-grade inflammation was evaluated by counting cells, including intraepithelial lymphocytes (IELs), eosinophils and mast cells, and by determining the mRNA and protein expression of tumour necrosis factor (TNF)-α in biopsies and culture supernatants. RESULTS: IBS-like symptoms were present in 35.4 and 38% of CD and UC patients, respectively. Paracellular permeability was significantly increased in both quiescent IBD with IBS-like symptoms and IBS compared with quiescent IBD without IBS-like symptoms (p<0.01, respectively) or controls (p<0.01, respectively). Significantly lower expression of ZO-1 and α-catenin was detected in IBS and quiescent IBD with IBS-like symptoms. IELs and TNF-α were significantly increased in quiescent IBD with IBS-like symptoms, but not in IBS. CONCLUSIONS: In quiescent IBD, IBS-like symptoms related to persistent subclinical inflammation associated with increased colonic paracellular permeability. A persistent increase in TNF-α in colonic mucosa may contribute to the epithelial barrier defects associated with abdominal pain in quiescent IBD, but not in IBS. Optimisation of anti-inflammatory therapy may be considered in quiescent IBD with IBS-like symptoms.

Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome.

The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p 0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p 0.08), followed by Legionella pneumophila (3% vs. 6%; p 0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p <0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p 0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4 days). The early (<48 h) (3.5 vs. 0.5%; p 0.04) and overall case-fatality rates (12% vs. 3%; p <0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality.

Renal function improvement after conversion to proliferation signal inhibitors during long-term follow-up in heart transplant recipients.

INTRODUCTION: The use of proliferation signal inhibitors (PSIs) for calcineurin-inhibitor (CNI) minimization or conversion protocols has been promoted for heart transplantation (HT) in the contexts of renal insufficiency, cardiac allograft vasculopathy (CAV), or malignancy. We evaluated our experience with conversion of patients from a CNI-based to a PSI-based immunosuppressive regimen. We focused on improvement in renal function. METHODS: This prospective follow-up included 96 HT patients converted to a PSI-based regimen from 2001 to 2010. We evaluated changes in creatinine clearance (CrCl) prior to at 1 year and at the end of follow-up after conversion. RESULTS: Ninety-six patients including 86% men showed a mean age of 62 ± 8 years. They were converted to a PSI-based regimen at 6.3 ± 4 years post-HT due to the following causes: CNI toxicity (45%), CAV (16%), cancer (16%), CNI toxicity + CAV (17%), or CNI toxicity + cancer (6%). CNI withdrawal was achieved in 77 cases (80%) and minimization in 19 (20%). Everolimus was used in 54 (56%) and sirolimus in 42 (44%) cases. Median follow-up time was 3.8 years. PSI discontinuation due to side effects was common (38%). There were 43 deaths mainly due to cancer and CAV. CrCl improved albeit not significantly in the withdrawal group from a median of 51 mL/min preconversion to 59 mL/min at the last follow-up (P = .12). In the minimization group, median CrCl worsened from a median of 61 mL/min preconversion to 51 mL/min at the last follow-up (P = .001). In the 58 cases (61%) of CNI nephrotoxicity, median CrCl improved from a median of 41 mL/min preconversion to 49 mL/min at the last follow-up (P = .04). CONCLUSION: Despite high rates of discontinuation of PSIs during long-term follow-up, the conversion regimen seemed to be useful to diminish CNI-related renal insufficiency especially with CNI withdrawal.

Luxación del polietileno en prótesis patelo-femoral con patela móvil. Caso clínico / Dislocation of the polyethylene in a patello-femoral replacement with a movable patella

La artroplastia femoro-patelar continúa siendo una técnica quirúrgica poco utilizada por los discutidos resultados obtenidos. En un intento de mejorar sus resultados se introdujo el diseño con polietileno móvil. Presentamos un caso clínico con una complicación poco frecuente: la luxación del polietileno de la base metálica de la patela; y a propósito realizamos una revisión bibliográfica de esta complicación (AU)

Patellofemoral arthroplasty is an infrequently used surgical technique because of its controversial results. In an attempt to improve the results, a design with a mobile-bearing poliethylene patellar component has been developed. We describe a clinical case with an unusual complication: the dislocation of poliethylene from the metal backing; and accordingly, we carried out a literature review of this complication (AU)

Infección estafilocócica diseminada con manifestaciones clínicas Kawasaki-like / Disseminated staphylococcal infection resembling Kawasaki disease

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Combination of allergic factors can worsen diarrheic irritable bowel syndrome: role of barrier defects and mast cells.

OBJECTIVES: Recent evidence suggests a role for increased colonic permeability and mucosal mast cell (MC) mediators on symptoms related to the irritable bowel syndrome (IBS). Whether allergic factors (AFs) are involved in the pathophysiology of IBS is unclear. We addressed the question of the possible influence of an allergic background on IBS symptoms. METHODS: We assessed paracellular permeability, mucosal MCs counts, and spontaneous release of tryptase of colonic biopsy specimens in 34 IBS patients and 15 healthy subjects. The severity of IBS was assessed through self-reported questionnaires. All individuals were tested for the presence of AF, including self-perception of adverse reaction to food, personal and familial history of atopic disease, elevated total or specific immunoglobulin E against food/inhalant antigens, blood eosinophilia, and skin tests. RESULTS: IBS patients had significant enhanced colonic permeability, higher number of MCs, and spontaneous release of tryptase than healthy subjects. The severity of IBS was significantly correlated with colonic permeability (r=0.48, P=0.004), MCs counts (r=0.36, P=0.03), and tryptase (r=0.48, P=0.01). In 13 IBS patients (38.2%) having at least three AFs, symptoms scores, colonic permeability, MCs counts, and tryptase release by colonic biopsies were significantly higher than in those with less than three AFs. IBS patients with at least three AFs were more prone to diarrhea or alternating symptoms. None AF was found to be predictive of IBS severity. CONCLUSIONS: In IBS patients, the presence of an allergic background correlates with a more severe disease and diarrhea predominance, possibly by enhancing mucosal MC activation and paracellular permeability.

[Dislocation of the polyethylene in a patello-femoral replacement with a movable patella]. / Luxación del polietileno en prótesis patelo-femoral con patela móvil. Caso clínico.

Patellofemoral arthroplasty is an infrequently used surgical technique because of its controversial results. In an attempt to improve the results, a design with a mobile-bearing poliethylene patellar component has been developed. We describe a clinical case with an unusual complication: the dislocation of poliethylene from the metal backing; and accordingly, we carried out a literature review of this complication.

Brote de 400 casos de lipoatrofia semicircular en Barcelona: efectividad de las medidas de control / An Outbreak of 400 Cases of Lipoatrophia Semicircularis in Barcelona: Effectiveness of Control Measures

Objetivos. Entre febrero de 2007 y octubre de 2008 se registraron 1137 casos de lipoatrofia semicircular en distintoscentros de trabajo de Barcelona. Se diseñó un protocolo para implementar medidas de control. En este estudio se evalúa laefectividad de dichas medidas.Métodos. Se analiza la evolución del brote en relación con las medidas implementadas (control de la humedad relativapor encima del 50%, tomas de tierra para la descarga eléctrica y evitar mesas con bordes angulosos). La población de estudioconsiste en 417 trabajadores de cuatro diferentes centros diagnosticados entre febrero de 2007 y octubre de 2008.Resultados. Las incidencias acumuladas en los cuatro centros de trabajo incluidos en el estudio fueron 61,6% (centrode trabajo 1, CT1), 24,1% (CT2), 8,8% (CT4) y 5,5% (CT3). Según la información sobre altas laborales confirmadaspor los servicios médicos, la frecuencia de curación fue más elevada en el CT1 (93%), seguido por el CT2 (82%), el CT4(62%) y el CT3 (22%).Conclusiones. Cuando se aplicaron rápida y conjuntamente las tres medidas básicas de control, el 90% de los afectadosse recuperaron en un plazo de 6 meses(AU)

Objective. From February 2007 to October 2008, 1137 cases of lipoatrophia semicircularis were registered in distinctworkplaces (WPs) in Barcelona. A protocol to establish control measures was designed. This study pretends to evaluate theeffectiveness of these measures.Methods. In this case study, the outbreak course in relation to the implemented measures (relative humidity >50%,ground-mass electrical discharge, and avoidance of sharp-ended table edges) was analyzed. The study population consistedof 417 workers from four different WPs diagnosed between February 2007 and October 2008.Results. Cumulative incidences were 61.6% (WP1), 24.1% (WP2), 8.8% (WP4), and 5.5% (WP3). Based on dischargesconfirmed by medical services, healing rate was highest in WP1 (93%), followed by WP2 (82%), WP4 (62%), and WP3(22%).Conclusions. When the three basic measures were promptly and jointly applied, 90% of the cases were resolved within6 months(AU)