Frailty, Sarcopenia and Osteoporosis. / Fragilidad, sarcopenia y osteoporosis.

Frailty, sarcopenia and osteoporosis are entities specific to the elderly, who share some risk factors. For this reason, their relationship has been studied in different works, which have provided disparate results, probably because these studies have not always focused on the same aspects. This article reviews the relationship of frailty and sarcopenia with osteoporosis.

Switch to ocrelizumab in MS patients treated with natalizumab in extended interval dosing at high risk of PML: A 96-week follow-up pilot study.

We aimed to assess the long-term safety and effectiveness of ocrelizumab in a cohort of patients with multiple sclerosis (MS) at high risk of progressive multifocal leukoencephalopathy (PML), previously treated with natalizumab in extending interval dosing (EID), who switched to ocrelizumab and to compare them with patients who continued EID-natalizumab. Thirty MS patients previously treated with natalizumab in EID (every 8 weeks) were included in this observational retrospective cohort study. Among them, 17 patients were switched to ocrelizumab and 13 continued with EID-natalizumab. Except for the John Cunningham virus (JCV) index, no significant differences were detected between both groups. Main outcome measures included: annualized relapse rate (ARR), radiological activity, disability progression, and the NEDA-3 index. Patients were followed for 96 weeks. The median washout period in ocrelizumab-switchers was 6 weeks. Among them, AAR and radiological activity during follow-up were 0.03, without significant differences in comparison with the previous period on natalizumab-EID. The comparison between ocrelizumab-switchers and patients continuing on EID-natalizumab showed no significant differences in AAR, radiological activity, or disability progression. However, the proportion of patients maintaining a NEDA-3 status in week 96 was slightly superior among ocrelizumab-switchers (94 vs 69%). No serious adverse events were observed in any group. In conclusion, switching from EID-natalizumab to ocrelizumab can be considered as a therapeutic option, particularly in patients with MS at high risk of PML, to mitigate the risks of both PML and disease reactivation.

Sarcopenic osteoporosis, sarcopenic obesity, and sarcopenic osteoporotic obesity in the Camargo cohort (Cantabria, Spain).

The associations of sarcopenia with osteoporosis or obesity have a very low prevalence. No trend towards an association between osteoporosis and sarcopenia is observed. Sarcopenia and obesity tend not to coincide, as if they were antagonistic disorders. PURPOSE: To know (a) the prevalence in our region of sarcopenic osteoporosis (association of sarcopenia and osteoporosis (T-score < - 2.5)), sarcopenic obesity, and the association of osteoporosis, sarcopenia, and obesity; (b) the tendency of osteoporosis, sarcopenia, and obesity to associate with each other; and (c) the bone mineral density (BMD), the components of sarcopenia, and the prevalence of fragility fractures in these associations. METHODS: The study was performed in the Camargo cohort. Osteoporosis was diagnosed by DXA, sarcopenia by the EWGSOP-1 criteria, and obesity by body mass index (BMI) and fat percentage. Fractures were verified radiographically or by consulting the medical records. RESULTS: The prevalence of sarcopenic osteoporosis was 2.8% and the OR for this association 1.03 (p = 0.89). The prevalence of sarcopenic obesity by BMI was 1.4% and by fat percentage 5.9% (corresponding ORs: 0.18 (p < 0.0001) and 0.58 (p < 0.003) respectively). The prevalence of the association of osteoporosis, sarcopenia, and obesity was 0.0% when assessed by BMI and 0.8% when assessed by fat percentage. Patients with sarcopenic osteoporosis have less muscle mass and more fragility fractures than sarcopenic patients overall. In patients with sarcopenic obesity by fat percentage, muscle mass and strength, as well as physical performance, were similar to those of sarcopenic patients overall. Neither BMD nor fracture prevalence showed differences between patients with sarcopenic obesity and patients with sarcopenia or obesity in general. CONCLUSION: Our study supports the idea that the prevalence of the mixed disorders studied is low. No significant association between osteoporosis and sarcopenia was found. Sarcopenia and obesity seem to tend to occur in different people, as if suffering from one of them hinders suffering from the other.

Hospitalización domiciliaria en un área rural, ¿una alternativa a la hospitalización tradicional? / Home care services provided by hospital in a rural area, an alternative to traditional hospitalization?

INTRODUCCIÓN: El servicio de hospitalización domiciliaria en el área rural es un servicio poco conocido en el resto del ámbito sanitario. Al mismo tiempo existe poca literatura al respecto por lo que con este estudio queremos estudiar las características clínicas, la estancia media y la tasa de reingresos de los pacientes que ingresan en hospitalización domiciliaria en comparación a los pacientes que ingresan en planta de medicina interna pertenecientes a un hospital comarcal de un área rural (Hospital de TresMares). MÉTODO: Estudio descriptivo comparativo retrospectivo que incluye un total de 200 pacientes (100 ingresados en hospitalización domiciliaria y 100 ingresados en planta) del hospital de TresMares. RESULTADOS: La complejidad de los pacientes que ingresan en planta es superior a los que ingresan en hospitalización domiciliaria requiriendo al mismo tiempo de mayor uso de recursos. La eficacia, entendida como tasa de reingreso, en hospitalización a domicilio es similar a la de los pacientes de la planta. Se demuestra que la hospitalización domiciliaria puede ser una alternativa a la hospitalización tradicional en un área rural. CONCLUSIONES: Se demuestra que la hospitalización domiciliaria puede ser una alternativa a la hospitalización tradicional en un área rural

INTRODUCTION: Hospital home care in a rural area is a hospital care little known in health field. At the same time there is little literature so we want to study the clinical characteristics, the average stay and the readmission rate of patients admitted to home hospitalization compared to patients admitted to the internal medicine hospitalization to a regional hospital in a rural area (Hospital de TresMares). METHOD: retrospective comparative descriptive study includes 200 patients (100 patients admitted to home hospitalization and 100 patients admitted to the hospital). RESULTS: the complexity of the patients admitted to the hospital is greater than those admitted to home hospitalization, while requiring greater use of resources. The efficacy, understood as re admission rate, in hospitalization at home is similar that the patients who are admitted in the hospital. CONCLUSIONS: home hospitalization can be an alternative to tradicional hospitalization in a rural are

Infección por Oerskovia turbata / Oerskovia turbata infection

No disponible

Evaluation of a deep learning system for the joint automated detection of diabetic retinopathy and age-related macular degeneration.

PURPOSE: To validate the performance of a commercially available, CE-certified deep learning (DL) system, RetCAD v.1.3.0 (Thirona, Nijmegen, The Netherlands), for the joint automatic detection of diabetic retinopathy (DR) and age-related macular degeneration (AMD) in colour fundus (CF) images on a dataset with mixed presence of eye diseases. METHODS: Evaluation of joint detection of referable DR and AMD was performed on a DR-AMD dataset with 600 images acquired during routine clinical practice, containing referable and non-referable cases of both diseases. Each image was graded for DR and AMD by an experienced ophthalmologist to establish the reference standard (RS), and by four independent observers for comparison with human performance. Validation was furtherly assessed on Messidor (1200 images) for individual identification of referable DR, and the Age-Related Eye Disease Study (AREDS) dataset (133 821 images) for referable AMD, against the corresponding RS. RESULTS: Regarding joint validation on the DR-AMD dataset, the system achieved an area under the ROC curve (AUC) of 95.1% for detection of referable DR (SE = 90.1%, SP = 90.6%). For referable AMD, the AUC was 94.9% (SE = 91.8%, SP = 87.5%). Average human performance for DR was SE = 61.5% and SP = 97.8%; for AMD, SE = 76.5% and SP = 96.1%. Regarding detection of referable DR in Messidor, AUC was 97.5% (SE = 92.0%, SP = 92.1%); for referable AMD in AREDS, AUC was 92.7% (SE = 85.8%, SP = 86.0%). CONCLUSION: The validated system performs comparably to human experts at simultaneous detection of DR and AMD. This shows that DL systems can facilitate access to joint screening of eye diseases and become a quick and reliable support for ophthalmological experts.

Current Approach in the Diagnosis and Management of Uveitic Glaucoma.

Uveitic glaucoma (UG) typically is associated with very high intraocular pressure (IOP) and more intense optic nerve damage than other glaucoma types. This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma. It is mandatory to identify the mechanisms of IOP elevation that in many eyes have multiple combined mechanisms. Management of these patients commonly requires an interdisciplinary approach that includes a glaucoma specialist and rheumatologist to control the inflammation and IOP. Glaucoma surgery is required early in these patients due to the high IOP usually present and is less successful than in primary open-angle glaucoma. Recurrent uveitic episodes, multiple mechanism, and the complications associated with uveitis make surgical management of UG challenging. In this review, the management and treatment of UG are updated to clarify the pathogenesis and prevent optic nerve damage.