[Nutritional control in orthopedic surgery patients]. / Control nutricional en pacientes de traumatología.

OBJECTIVE: To assess the nutritional status of orthopaedic patients. DESIGN: Prospective observation study. SETTING: Tertiary hospital, Clinical Nutrition Unit. PATIENTS: 107 patients (56.1% women, 43.9% men, 62.1 +/- 20.4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis. MATERIAL AND METHODS: Medical history, anthropometric data and three nutritional screening tools were considered: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). It was assessed the prevalence of malnutrition in patients on admission to hospital, using different methods and determining if a correlation exists between malnutrition and other factors, such as the development of pressure sores of the dependence in activities of daily living. RESULTS: The risk of malnutrition is 22 and 24/100 patients admitted at hospital, if MNA and SGA are used, respectively (SGA caregorized 4% of the group as "malnourished"). 80% patients are considered to be at high risk of malnutrition using MUST. 1.7% patients presented a Body Mass Index (BMI) lower than 18.5. There is a strong agreement between malnutrition and neropsychological status (p = 0.001), and the dependence in activities of daily living (p = 0.002), and between medium and high risk of malnutrition and the development of pressure sores (p = 0.003). If MNA and SGA (p = 0.000) are used, post-surgical patients presents a deteriorating nutritional status. CONCLUSIONS: The prevalence of malnutrition in patients on admission to hospital is elevated. Orthopaedic surgery patients with hip and knee prosthesis presented a deteriorating nutritional status, and a higher incidence of pressure sores in a month.

[Tuberculosis in the elderly in a general hospital in the Region of Madrid, 1994-2003]. / Tuberculosis en ancianos en un hospital general de la Comunidad de Madrid, 1994-2003.

INTRODUCTION: Tuberculosis in the elderly is a health problem that is on the increase nowadays in industrialised countries. The aim of this study is to describe epidemiological, clinical and microbiological characteristics of tuberculosis in elderly patients in a general hospital in the Region of Madrid from 1994 to 2003. METHODS: Only microbiologically and/or histopathologically confirmed tuberculosis were studied. Epidemiological, clinical and microbiological variables were analyzed. Microbiological and histopathological laboratory results and medical records were collected. RESULTS: The proportion of cases occurring among the elderly rose from 12.4% between 1994 and 1998 to 17.8% between 1999 and 2003 (p <0.05). A total of 160 tuberculosis cases were studied: 92.5% were microbiologically (culture) confirmed and 7.5% histopathologically confirmed. The average time to culture positivity was 18.8 days (SD: 6.5). 88.7% isolates were susceptible to streptomycin, isoniazid, rifampin, ethambutol, and pyrazinamide. The main locations of tuberculosis were pulmonary (59.4%), ganglionary (11.9%) and genitourinary (10.0%). A positive smear in the sputum was discovered for 52.6% of pulmonary tuberculosis. The most prevalent risk factors were immunosuppression (14.8%) and diabetes mellitus (12.3%). Neither of them were VIH, intravenous drug users or immigrants. 50.7% cases were hospitalized. CONCLUSIONS: Tuberculosis in the elderly is on the increase in our region nowadays. The epidemiological pattern of tuberculosis in the elderly differs from that observed in younger patients. Therefore specific control and prevention strategies are needed in order to reduce tuberculosis incidence in aged populations.

[Hepatitis B prevention and risk of HIV infection in children injured by discarded needles and/or syringes]. / Prevención de hepatitis B y riesgo de infección por VIH en niños accidentados con agujas y/o jeringuillas abandonadas.

OBJECTIVES: Main aim: to study the application of mixed prophylaxis against Hepatitis B viral infection (HB) in children injured by discarded needles and/or syringes. Secondary aim: to find in the group under study the incidence of HIV infection caused by these accidents. DESCRIPTION: Descriptive study. SETTING: 12 de octubre University Hospital, Madrid. PATIENTS: Children injured by discarded needles and/or syringes and referred to the Preventive Medicine Service between May 1988 and April 1995 (7 years). INTERVENTIONS: 1) Serological study for HB and HIV; 2) application to unprotected children of HB mixed prophylaxis (specific Immunoglobulin--IGHB--plus vaccination) and 3) Post-vaccination serological check-ups for HB and HIV at 6 and 12 months from the incident. MEASUREMENTS AND MAIN RESULTS: 249 children, whose average age was 5.8 +/- 3.37, were seen (158 boys, 63.5% and 91 girls, 36.5%). 189 (75.9% of the total) received a dose of IGHB and 171 (71.8%) completed the HB vaccinations. Post-vaccination serological check-ups covered 144 children (84.2%). 101 children (40.6%) completed the HIV check-ups. No HIV infection was detected. CONCLUSIONS: 1) HB mixed prophylaxis in children without serological protection is adequate for dealing with these incidents. 2) The risk of HIV infection should not be discounted, but is probably very slight. 3) The procedure should be put into practice in PC, with some shortening of HIV follow-up periods, as a measure to improve compliance.

Spontaneous abortion in a hospital population: are tobacco and coffee intake risk factors?

The objective of this study was to examine the possible relationships between spontaneous abortion and caffeine, tobacco and alcohol intake in a well-controlled group of hospital workers. A retrospective cohort study design including 711 women, 20 to 41 years old, was used. All data regarding the purpose of this study were extracted from clinical histories registered at the Preventive Medicine Service. The dependent variable was spontaneous abortion and the independent variables were tobacco, coffee, and alcohol intake. Age, previous spontaneous abortion, menarcheal age and marital status were considered as potential confounders. The data were analyzed by multiple logistic regression. The following adjusted odds ratios of spontaneous abortion by caffeine consumption were calculated: 141-280 mg/day, 2.20 (1.22-3.96); 281-420 mg/day, 4.81 (2.28-10.14) and 421 or more, 15.43 (7.38-32.43); p < 0.05. The adjusted odds ratio for tobacco were 11 or more cigarettes/day, 3.35 (1.65-6.92); p < 0.05. It appears from this and other papers that tobacco and caffeine intake must be considered as clear risk factors for spontaneous abortion or miscarriage.

[Family background. Parity. Breast feeding and cancer of the breast]. / Antecedentes familiares. Paridad. Lactancia y cáncer de mama.

A study has been carried out of case-controls in a population of 482 women aged between 40 and 98. Of these, 194 had been diagnosed with breast cancer by means of a biopsy and the remaining 288 were controls whose lack of tumoral processes had been ensured by the usual diagnostic means. In the population under study we have found that the maternal family background in the first degree was a risk factor for breast cancer, while giving birth and breast-feeding, both one's own and one's children, acted as protective factor.