[Hip fracture in the elderly: epidemiology and costs of care]. / Fractura de cadera en el adulto mayor: epidemiología y costos de la atención.

INTRODUCTION: The aim of this study was to describe the epidemiology and to estimate the direct medical costs of hip fracture among elderly patients in Mexico. MATERIAL AND METHODS: An observational, cross sectional and retrospective study was undertaken. Hospital discharge and surgical procedures for the period 2013-2018 were the databases used for the analysis, and obtained from General Directorate of Health Information. Variables included were sex, federal entity, age, year of discharge, and fracture type according to the CIE-10; and also, the supplies needed for the surgical procedures. RESULTS: A total of 16,829 patients with hip fracture were discharge, 69% were women, and the mean for age was 79 years old and for the hospital stay length was nine days. The most frequent fracture type was the femur neck with 77% and the average medical costs was USD$45,122,228.00. CONCLUSION: Falling risks increase with age, especially in patients among 80-89 years of age, hence, is expected that this type of pathology increases in the following years. The medical costs for treatment of hip fracture represents an economic impact on health services. For that reason, the implementation of prevention strategies, risk of falling for example, is the one of most efficient approach.

INTRODUCCIÓN: El objetivo general de la investigación fue describir la epidemiología y estimar los costos médicos directos de la fractura de cadera en el adulto mayor en México. MATERIAL Y MÉTODOS: Se realizó un estudio observacional y transversal retrospectivo. Se utilizaron dos bases de datos obtenidas de la Dirección General de Información en Salud del período 2013-2018: egresos hospitalarios y procedimientos quirúrgicos. Las variables incluidas fueron: sexo, entidad federativa, edad, año de registro y tipo de fractura de acorde a la CIE-10; de igual forma, todos los insumos necesarios para la realización del procedimiento quirúrgico. RESULTADOS: Se registraron 16,829 ingresos de pacientes con fractura de cadera. Las mujeres representaron 69% del total de pacientes, la edad en promedio fue de 79 años y la estancia hospitalaria fue de nueve días, 77% de las fracturas fueron de cuello de fémur y el promedio de los costos médicos directos de los procedimientos ascendieron a USD $45,122,228.00 para el período estudiado. CONCLUSIÓN: El riesgo de caídas aumenta con la edad, especialmente en el grupo etario de 80-89 años, por lo que se espera que este tipo de patologías se incremente en los próximos años. De igual forma, los costos para la atención de estas fracturas representan un impacto económico para los sistemas de salud. De manera que la implementación de estrategias de prevención, por ejemplo, en caídas es el método más eficiente para contribuir al envejecimiento saludable.

Renal interstitial sclerosis in aging: effects of enalapril and nifedipine.

The effects of nifedipine and enalapril on age-associated renal interstitial fibrosis were investigated in 60 CF1 female mice. Mice received 20 mg enalapril (ENAL) per L (N = 20), or 40 mg nifedipine (NIF) per L (N = 20) in their drinking water. Control (CONT) mice received tap water ad libitum. The percentages of both interstitial peritubular sclerosis (IPS) in cortex and interstitial medullary sclerosis (IMS) were determined. Kidney tissue was studied using immunological techniques and optical (OM) and electron microscopy (EM) to analyze the expression of renin. alpha-SM-actin and vimentine expression were also evaluated. The results showed that blood pressure levels in ENAL or NIF animals were not different from those of CONT. Renin expression was observed in arcuate vessels (AV) in ENAL animals, whereas no renin staining in AV was found in either NIF or CONT animals. Renin immunoreactivity in the juxtaglomerular apparatus was more intense in ENAL mice, as compared with NIF or CONT animals. Laboratory testing showed the following values: proteinuria (mg/mL): CONT 6.1 +/- 0.6, NIF 11.2 +/- 2.3, and ENAL 1.0 +/- 0.6 (P < 0.05); creatinine: CONT 1.37 +/- 0.24, NIF 0.87 +/- 0.16, and ENAL 0.63 +/- 0.1 (P < 0.01). The percentages of interstitial sclerosis were: %IPS: CONT 18.12 +/- 1.1, NIF 17.40 +/- 0.9, and ENAL 3.42 +/- 1.3 (P < 0.01); %IMS: CONT 23.41 +/- 1.5, NIF 21.80 +/- 1.9, and ENAL 6.12 +/- 1.2 (P < 0.01). Percentages of alpha-SM-actin expression were: CONT 13.10 +/- 1.9, NIF 13.80 +/- 0.2, and ENAL 1.00 +/- 0.1 (P < 0.01). Vimentine staining showed no differences among the groups. It was concluded that enalapril reduces the peritubular and medullar interstitial fibrosis, whereas nifedipine has no effect.

Síntesis de renina por células renales durante la inhibición crónica de la enzima convertidora de la angiotensina I / Renin synthesis by renal cells during chronic inhibition of angiotensin I converting enzyme

Se realizó un estudio sobre la síntesis de renina y las modificaciones en el número de células que se produce durante la inhibición crónica de la enzima convertidora de la Ang II en ratones. Veinte ratones CF1, hembras de 15 días de edad, inmediatamente después del destete, recibieron 20 mg/l de maleato de enalapril (ME) con el agua de beber durante 18 meses y se compararon con un grupo control. El tejido renal fue procesado y estudiado con técnicas inmunohistoquímicas con microscopía óptica y electrónica utilizando un anticuerpo policlonal antirrenina y se realizó hibridización in situ para rasteo de ARNm de renina con una sonda marcada con diagoxigenina. Los parámetros calculados fueron el número de aparatos yuxtaglomerulares (MAYG), de arteriolas aferentes (AA) y vasos arcuatos (VA) inmunomarcados con antirrenina y con antidigoxigenina. Con microscopía electrónica se determinó el número de partículas de oro por gránulo de renina. Se demostró aumento del número de células productoras de renina en los animales que recibieron crónicamente ME, más allá del AYG y de la AA ya que se observó marcación en vasos arcuatos. La media de porcentagem MAYG y porcentagemMAA fue menor en los animales controles (Con) que en los tratados (TRA). No se marcaron los VA en el grupo Con, y sí en los animales Tra. La distribución del ARN fue diferente en los animales con inhibición del SRA que en los controles. Los signos de hibridización fueron significativamente menores en los animales Con, tanto el porcentagemSAYG, el porcentagemSAA. En los VA sólo se observaron signos en los animales tratados porcentagem SVA. La cantidad de partículas de oro en las células productoras de renina fue diferente entre los dos grupos de animales. La media del número de partículas de oro en los gránulos de renina perteneciente al AYG de los animales Con. fue significativamente menor que en los tratados. En este trabajo se demostró que los animales que tienen inhibido crónicamente la producción de Ang II por ME, aumentan la síntesis, el número y la localización de células productoras de renina en la vasculatura renal, recapitulando situaciones que ocurren durante el desarrollo embriológico de mamíferos y en vertebrados primitivos adultos

Síntesis de renina por células renales durante la inhibición crónica de la enzima convertidora de la angiotensina I / Renin synthesis by renal cells during chronic inhibition of angiotensin I converting enzyme

Se realizó un estudio sobre la síntesis de renina y las modificaciones en el número de células que se produce durante la inhibición crónica de la enzima convertidora de la Ang II en ratones. Veinte ratones CF1, hembras de 15 días de edad, inmediatamente después del destete, recibieron 20 mg/l de maleato de enalapril (ME) con el agua de beber durante 18 meses y se compararon con un grupo control. El tejido renal fue procesado y estudiado con técnicas inmunohistoquímicas con microscopía óptica y electrónica utilizando un anticuerpo policlonal antirrenina y se realizó hibridización in situ para rasteo de ARNm de renina con una sonda marcada con diagoxigenina. Los parámetros calculados fueron el número de aparatos yuxtaglomerulares (MAYG), de arteriolas aferentes (AA) y vasos arcuatos (VA) inmunomarcados con antirrenina y con antidigoxigenina. Con microscopía electrónica se determinó el número de partículas de oro por gránulo de renina. Se demostró aumento del número de células productoras de renina en los animales que recibieron crónicamente ME, más allá del AYG y de la AA ya que se observó marcación en vasos arcuatos. La media de porcentagem MAYG y porcentagemMAA fue menor en los animales controles (Con) que en los tratados (TRA). No se marcaron los VA en el grupo Con, y sí en los animales Tra. La distribución del ARN fue diferente en los animales con inhibición del SRA que en los controles. Los signos de hibridización fueron significativamente menores en los animales Con, tanto el porcentagemSAYG, el porcentagemSAA. En los VA sólo se observaron signos en los animales tratados porcentagem SVA. La cantidad de partículas de oro en las células productoras de renina fue diferente entre los dos grupos de animales. La media del número de partículas de oro en los gránulos de renina perteneciente al AYG de los animales Con. fue significativamente menor que en los tratados. En este trabajo se demostró que los animales que tienen inhibido crónicamente la producción de Ang II por ME, aumentan la síntesis, el número y la localización de células productoras de renina en la vasculatura renal, recapitulando situaciones que ocurren durante el desarrollo embriológico de mamíferos y en vertebrados primitivos adultos (AU)

Intraglomerular expression of alpha-smooth muscle actin in aging mice.

To determine whether chronic treatment with enalapril initiated early in life prevents glomerular injury secondary to normal aging, CF1 mice received enalapril (20 mg/L, n = 10) or nifedipine (40 mg/L, n = 10) in their drinking water from the time of weaning to 12 months of life. Control mice (n = 10) received tap water ad libitum. Immunocytochemical detection of renin confirmed that angiotensin-converting enzyme inhibition resulted in recruitment of renin-containing cells along the preglomerular vessels. Morphometric analysis of glomeruli included assessment of glomerular diameter and the percentage of mesangial area per glomerulus. Glomerular diameter and mesangial area were higher in control mice (99.7 +/- 0.5 microns, 12.7 +/- 0.3%) than in enalapril-treated mice (88 +/- 0.8 microns, 8.6 +/- 0.6%) (P < .05). Glomerular diameter and mesangial area in the nifedipine-treated group (99.1 +/- 0.9 microns, 12.4 +/- 0.9%) were not different from control mice. These results demonstrate that angiotensin-converting enzyme inhibition prevents the glomerular enlargement and mesangial expansion observed during natural aging. In addition, control glomeruli expressed alpha-smooth muscle actin in a mesangial distribution. This effect was prevented by enalapril treatment but not by nifedipine. We conclude that long-term treatment with enalapril from early life prevents the early changes associated with glomerular injury and expression of alpha-smooth muscle actin in the glomerulus. alpha-Smooth muscle actin may participate in and serve as an early marker of the glomerular injury during the normal aging process.

[Renin synthesis by renal cells during chronic inhibition of angiotensin I converting enzyme]. / Síntesis de renina por células renales durante la inhibición crónica de la enzima convertidora de la angiotensina I.

A study was performed on renin synthesis in order to evaluate changes that occur in renal cells during angiotensin-converting enzyme chronic inhibition of Ang I in mice. Immediately after weaning, 20 CF1 mice received 20 mg/l enalapril maleate in drinking water during 16 months; this group was compared with a control group. Kidney tissue was processed and studies using optical and electron microscope immunochemical techniques were performed. An antirenin antibody was used, and in situ hybridization was performed to keep track of renin mRNA with a digoxygenin-marked probe. We calculated the number of juxtaglomerular apparatus (JGA), afferent arterioles (AA) and arcuate vessels (AV) immunomarked (IM) with antirenin and antidigoxygenin. These parameters were rendered in JGA rates (%IMJGA) and AA (%IMAA) and AV (%IMAV) marked rates (%AV), and in the rate of JGA (%SJGA), AA (%SAA) and AV (%SAV) hybridization signs. Electron microscope readings were used to determine the number of gold particles per renin granule. An increase in the number of renin-producing cells was observed in animals having received enalapril chronically, beyond AJG and AA, since marking was observed in arcuate vessels. The mean %MJGA value was lower in control animals (65.6% +/- 2.4) than in treated animals (94.2% +/- 3 p < 0.05). Similar findings occurred with %MAA: 23.6% +/- 3, (control animals) vs. 41.6% +/- 2.3, p < 0.05 (treated animals). AV were not marked in the control group, as they were in treated animals where %MAV was 4.4% +/- 1.6. The mRNA distribution was different in animals with RAS inhibition as compared with control animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Síntesis de renina por células renales durante la inhibición crónica de la enzima convertidora de la angiotensina I. / [Renin synthesis by renal cells during chronic inhibition of angiotensin I converting enzyme]

A study was performed on renin synthesis in order to evaluate changes that occur in renal cells during angiotensin-converting enzyme chronic inhibition of Ang I in mice. Immediately after weaning, 20 CF1 mice received 20 mg/l enalapril maleate in drinking water during 16 months; this group was compared with a control group. Kidney tissue was processed and studies using optical and electron microscope immunochemical techniques were performed. An antirenin antibody was used, and in situ hybridization was performed to keep track of renin mRNA with a digoxygenin-marked probe. We calculated the number of juxtaglomerular apparatus (JGA), afferent arterioles (AA) and arcuate vessels (AV) immunomarked (IM) with antirenin and antidigoxygenin. These parameters were rendered in JGA rates (

IMJGA) and AA (

IMAA) and AV (

IMAV) marked rates (

AV), and in the rate of JGA (

SJGA), AA (

SAA) and AV (

SAV) hybridization signs. Electron microscope readings were used to determine the number of gold particles per renin granule. An increase in the number of renin-producing cells was observed in animals having received enalapril chronically, beyond AJG and AA, since marking was observed in arcuate vessels. The mean

MJGA value was lower in control animals (65.6

+/- 2.4) than in treated animals (94.2

+/- 3 p < 0.05). Similar findings occurred with

MAA: 23.6

+/- 3, (control animals) vs. 41.6

+/- 2.3, p < 0.05 (treated animals). AV were not marked in the control group, as they were in treated animals where

MAV was 4.4

+/- 1.6. The mRNA distribution was different in animals with RAS inhibition as compared with control animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Phosphatidylserine increases hippocampal synaptic efficacy.

In the present study, the effects of phosphatidylserine (BC-PS) on hippocampal synaptic transmission were evaluated. Extracellular potentials evoked by low-frequency stimulation (0.2 Hz) of the perforant path (PP) were recorded from the granule cell layer of the dentate gyrus in 400 microns hippocampal slices. Slices were perfused with either BC-PS alone (10 microM) or BC-PS in combination with DL-2-amino-5-phosphonovaleric acid (APV, 20 microM), or after previous perfusion with dizocilpine (MK-801, 10 microM). BC-PS significantly potentiated PP-evoked responses (mean percent increase +/- SEM, 108 +/- 18%), an effect that was blocked by perfusion of MK-801, but not APV. The increase in hippocampal synaptic efficacy produced by BC-PS is discussed in terms of N-methyl-D-aspartate receptors (NMDA) and the associated channels.

Effect of acute ethanol exposure during pregnancy on dentate gyrus synaptic plasticity in 45-day-old rats.

Pregnant Wistar rats were treated during the eighth day of gestation (GD8) with two IP injections, spaced by an interval of 4 h, of either ethanol (2.9 g/kg in saline solution) or saline. At 45 days of age, rats prenatally exposed to alcohol showed an improved hippocampal synaptic plasticity in granule cells layer of dentate gyrus. This was assessed measuring the threshold to generate long-term potentiation (LTP) on hippocampal slices. We propose that this result might account for the good performance in some learning tasks observed in animals prenatally exposed to alcohol during short periods.

Differences in hippocampal synaptic plasticity in rats with inborn high or low learning ability may be related to different sensitivity of aspartate receptors.

Rats with an inborn high (HP) or low (LP) learning capacity were used to study the sensitivity to the blocking effect of 2-amino-phosphonopentanoic acid (AP5; 10 and 20 microM) on long-term potentiation (LTP) produced in hippocampal slices by a 1-s tetanus at 200 Hz. The potential evoked by stimulation of the perforant path was recorded from the granule cell layer of the dentate gyrus in 400 microns slices perfused with standard Krebs' solution or the AP5. Under perfusion with 10 microM of AP5, in 100% of slices from HP rats, LTP generation was not blocked; when AP5 20 microM was used, in 85% of the cases LTP was not blocked. In 60% of slices from LP rats, AP5 10 microM and in 100% of the cases at 20 microM AP5 blocked LTP generation. These results are coherent with the hypothesis that the different inborn learning ability of HP and LP rats is related to the different population or sensitivity of N-methyl-D-aspartate (NMDA) receptors.

Shuttle-box deficits induced by chronic variable stress: reversal by imipramine administration.

Escape performance in a shuttle-box task was evaluated in rats chronically exposed to a series of unpredictable stressors either during 14 or 7 consecutive days. Failure in escape responses was observed when animals were subjected to both regimes of variable aversive situations. The association between chronic exposure to unpredictable stressors with imipramine resulted in a significant reversal of escape deficits. Furthermore, animals submitted to repeated immobilization sessions during 7 days presented similar escape response to control rats. A possible involvement of beta-adrenergic sites on this behavioral response is discussed.

Long-term potentiation-induced synaptic changes in hippocampal dentate gyrus of rats with an inborn low or high learning capacity.

Structural changes induced by high frequency (HF) stimulation on granule cells of the hippocampal dentate gyrus of rats with inborn high (HP) and low (LP) learning capacity was examined in this study. Two types of axodendritic synapses were processed morphometrically; the axonal bouton on dendritic shafts and those making contact through dendritic spines. The occurrence of granule cell spine synapses on LP rats before tetanus is less than the one in control animals. However, after long-term potentiation (LTP) produced by HF stimulation the number of spine synapses decreased, as happened in the control rats. Moreover, the number of granule cells shaft synapses counted on LP rats, before tetanus is less than the one on control rats, and after LTP this number increased greatly. There was no change in the number of granule cell shaft synapses in HP rats before and after LTP. LP rats which did not show LTP in spite of HF stimulation did not show changes in the number of spine and shaft synapses. From these results we can conclude that: (1) the great hippocampal synaptic plasticity observed in HP rats compared to LP rats can be attributed, at least in part, to the increased number of spine and shaft synapses observed in HP rats; (2) the minor number of spine and shaft synapses in LP rats may account for the impossibility to obtain LTP after HF stimulation in these animals.

Gangliosides improve synaptic transmission in dentate gyrus of hippocampal rat slices.

The effect of perfusion with gangliosides (1 x 10(-6) M) on the response evoked in the granule cell layer of dentate gyrus by stimulation of perforant path in hippocampal rat slices was studied. Gangliosides induced both a decrease in the frequency threshold of stimulation necessary to generate long-term potentiation (LTP) and greater potentiation than under control conditions. It is proposed that gangliosides improve the mechanisms responsible for synaptic plasticity which generate LTP.

Colitis colágena: una buena razón para tomar biopsias de recto en pacientes con diarrea crónica

El motivo de presentar esta paciente es hacer consciencia entre el cuerpo médico de la existencia de esta entidad, de la cual hay muy pocos casos reportados en la literatura y sólo informe reciente en nuestro país. La colitis colágena es una entidad de etiología no aclarada que se caracteriza histológicamente por la presencia de una banda de colágeno mayor de 7 micras a nivel subepitelial de la mucosa colorrectal y clínicamente por diarrea crónica acuosa profusa, que puede asociarse con dolor abdominal tipo cólico, y estudios tanto de laboratorio como endoscópicos negativos. Se presenta un caso de esta entidad manejado recientemente en el Hospital Universitario del Valle, en quien se tomaron las biopsias aún en presencia de cambios endoscópicos. La respuesta terapéutica a la sulfasalazina y esteroides ha sido aceptable. Finalmente, sugerimos como recomendación que en pacientes con diarrea crónica no explicada, deben tomarse biopsias de colon y recto, a pesar de no presentar cambios endoscópicos