Summary
The relation between age and mortality after hip fracture was analyzed in elderly patients. 5.5% of the 31,884 patients died. Compared to those 65–74 years old, the multivariate OR for ...mortality for those 75–84 and ≥85 were 2.11 (95% CI: 1.61–2.77) and 4.10 (95% CI: 3.14–5.35).
Purpose
To analyze the impact of Elixhauser comorbidities on the relation between age and mortality after hip fracture in elderly patients.
Methods
Cross-sectional study of the population ≥65 years old hospitalized in Spain in 2013 with a diagnosis of fall-related hip fracture in the Basic Minimum Set Data (BMSD). The impact of Elixhauser comorbidities on the association between mortality and age groups (65–74, 75–84, ≥85) was analyzed by logistic regression models with progressive adjustment for demographic variables and comorbidities introduced individually.
Results
We identified 31,884 patients, 5.5% of which died during hospitalization. Compared with those 65–74 years old, the multivariate OR of mortality for those 75–84 and ≥85 years old decreased from 2.23 (95% CI: 1.71–2.90) and 4.57 (95% CI: 3.54–5.90) to 2.11 (95% CI: 1.61–2.77) and 4.10 (95% CI: 3.14–5.35), respectively after adjustment for comorbidities. The OR of mortality for men was 1.77 (95% CI: 1.58–1.98) compared to women. The comorbidities with higher OR for mortality were congestive heart failure (OR: 3.88; 95% CI: 3.42–4.41), metastasis (OR: 3.44; 95% CI: 2.27–5.20), fluid and electrolyte disorders (OR: 2.95; 95% CI: 2.47–3.52), coagulation deficiencies (OR: 2.87; 95% CI: 2.08–3.96), and liver disease (OR: 2.40; 95% CI: 1.82–3.17).
Conclusions
The association between age and mortality after hip fracture remains after adjusting for numerous comorbidities. However, some potentially controllable disorders are associated with an increased risk for mortality, thus, improving their management could benefit survival.
In November 2004, a regional climate change workshop was held in Guatemala with the goal of analyzing how climate extremes had changed in the region. Scientists from Central America and northern ...South America brought long‐term daily temperature and precipitation time series from meteorological stations in their countries to the workshop. After undergoing careful quality control procedures and a homogeneity assessment, the data were used to calculate a suite of climate change indices over the 1961–2003 period. Analysis of these indices reveals a general warming trend in the region. The occurrence of extreme warm maximum and minimum temperatures has increased while extremely cold temperature events have decreased. Precipitation indices, despite the large and expected spatial variability, indicate that although no significant increases in the total amount are found, rainfall events are intensifying and the contribution of wet and very wet days are enlarging. Temperature and precipitation indices were correlated with northern and equatorial Atlantic and Pacific Ocean sea surface temperatures. However, those indices having the largest significant trends (percentage of warm days, precipitation intensity, and contribution from very wet days) have low correlations to El Niño–Southern Oscillation. Additionally, precipitation indices show a higher correlation with tropical Atlantic sea surface temperatures.
Nearly 80% of the world's population trusts traditional medicine and plant-based drug compounds to improve health, and more than 50% of women who participated in a study have used herbal remedies ...during pregnancy.
L. is a plant native to tropical America, where infusion of its leaves has been widely used for the treatment of several gastrointestinal disorders. We have already shown that orogastric consumption of
L. during the organogenesis period at concentrations equivalent to human consumption produces teratogenic effects in rats, but effects on progeny development have not yet been studied. In this study, we aimed to investigate the possible association between the consumption of
L. at a dose equivalent to that consumed by humans and the neurological development of rat progeny. Pregnant Wistar rats were administered lyophilized
L. extract at 300 mg/kg/day or vehicle via the orogastric route during the organogenesis period (gestation days 7-13). The physical development and sensory and motor maturation of their offspring during lactation were analyzed with a battery of reflex and physical tests.
L. produced a significant delay in physical development and sensorimotor maturation, compared to the control group. Proton nuclear magnetic resonance spectroscopy analysis showed signals for both flavonoids and alkaloids in the
L. extract. We conclude that the delay in physical and neurological development could be interpreted as alterations in the maturation of some neuronal circuitries induced by
L.
Background and importanceDysphagia can occur due to a wide range of medical conditions including acute or progressive neurological disorders, trauma or surgery, with secondary effects such as ...dehydration and malnutrition causing an increase in morbidity and mortality rates. Dysphagia screening and assessment of swallowing function by a multidisciplinary care team is essential to identify, diagnose and manage patients with dysphagia.Aim and objectivesTo analyse the results of dysphagia screening and the benefit of including a hospital pharmacist in the multidisciplinary dysphagia screening team in an intermediate and long-stay hospital.Material and methodsA prospective study of dysphagia screening and subsequent interventions was performed over a 2-week period in all patients hospitalised in an intermediate and long-stay hospital. The multidisciplinary team responsible for dysphagia screening consisted of a registered nurse and a physician with the integration of a hospital pharmacist and nutritionist. The Eating Assessment Tool-10 (EAT-10) questionnaire was used as a direct-scoring screening test for dysphagia together with the standardised Volume-Viscosity Swallow Test (V-VST) in all patients with an EAT-10 score ≥3. After confirming the condition, different dietary and pharmaceutical interventions were performed. The following data were collected from the medical record program EKON: age, sex, primary diagnosis, diet and texture.Results86 patients (57% men) were included in the study with a mean age of 74 (39–102) years. The mean EAT-10 score was 8±9 points with 33 patients (38%) testing positive for being at risk of presenting dysphagia. Of these patients at risk, the V-VST detected dysphagia and the necessity of a nectar consistency in 21 patients (64%), a honey consistency in 2 patients (6%) and a pudding consistency in 2 patients (6%). Dietary and pharmaceutical interventions were made in 17 patients (68%) of those diagnosed with dysphagia, including modifications of the diet texture, tailoring of medical formulations available or drug administration mixed with more textured food.Conclusion and relevanceDysphagia screening in intermediate and long-stay hospitals is not common practice even though there is a high prevalence and important clinical repercussions in these settings. A hospital pharmacist plays an important role as part of the multidisciplinary team making the necessary pharmaceutical interventions needed in patients with dysphagia.References and/or acknowledgementsConflict of interestNo conflict of interest
Resumen: Introducción: Las fracturas transtrocantéricas representan 50% de las fracturas del fémur proximal con mayor incidencia en pacientes mayores de 65 años. El objetivo del estudio es evaluar la ...asociación de factores ortopédicos con la presencia de complicaciones mediatas en pacientes geriátricos postoperados de fracturas transtrocantéricas con sistema de tornillo dinámico de cadera (DHS, por sus siglas en inglés) de 135o. Material y métodos: Estudio retrospectivo, analítico. Evaluamos pacientes mayores de 65 años con fracturas transtrocantéricas tratados con DHS de 135o. Analizamos radiografías prequirúrgicas, postquirúrgicas a tres y seis meses. Realizamos un análisis descriptivo de las características poblacionales, análisis de comparación de medias (U de Mann Whitney) y de proporciones (χ2), análisis de correlación y un modelo de regresión logística para determinar el grado de asociación de los factores con complicaciones mediatas. Resultados: Evaluamos 92 pacientes con edad promedio de 83 ± 6.7 años. Evidenciamos complicaciones ortopédicas mediatas en 8.7%, considerando como la más frecuente el cut-out (5.4%). En el análisis de correlación el índice punta ápex > 25 tiene correlación débil (r = 0.372), mientras que el índice punta ápex modificado al calcar > 27 posee correlación moderada (r = 0.528). El ángulo cérvico-diafisario lateral > 20o tiene correlación alta (r = 0.7). En el análisis de regresión este último se asoció con presencia de complicaciones ortopédicas mediatas (OR 4.93, IC 1.2-15.81, p = 0.000). Conclusiones: Se observó correlación entre factores como el índice punta ápex > 25, índice punta ápex modificado al calcar > 27 y ángulo cérvico-diafisario lateral > 20o con presencia de complicaciones, destacando este último como el factor que presenta asociación con diferencias estadísticamente significativas.
Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in ...children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.
La pancreatitis aguda (PA) y la pancreatitis aguda recurrente (PAR) son enfermedades cuya incidencia aparentemente va en incremento. A pesar de la creciente evidencia sobre el manejo de la PA en adultos y niños, aún se siguen teniendo conductas que potencialmente podrían impactar en un pronóstico no tan adecuado de estos pacientes, sobre todo en población pediátrica. Es por esto que la Asociación Mexicana de Gastroenterología convocó a un grupo de 24 gastroenterólogos pediatras expertos, de diferentes instituciones y de diferentes zonas geográficas de México, 2 nutriólogas pediatras, así como 2 especialistas en cirugía pediátrica para discutir sobre diferentes aspectos de la epidemiología, diagnóstico y tratamiento de la PA y PAR en población pediátrica. El objetivo de este documento es presentar los resultados obtenidos de este consenso. Se organizaron 6 mesas de trabajo con diferentes tópicos sobre la PA. Cada mesa de trabajo revisó la información y generó los enunciados/declaraciones que consideraron pertinentes para cada módulo, en tópicos que representaran recomendaciones o puntos de debate sobre cuestiones de abordaje diagnóstico o terapéutico. Se presentaron y discutieron todas las declaraciones. Posteriormente, se sometieron a evaluación mediante un proceso Delphi, de voto anónimo, vía electrónica, para conocer el nivel de acuerdo en los enunciados/declaraciones. Se elaboraron un total de 29 enunciados/declaraciones. Todas las declaraciones tuvieron un porcentaje de consenso mayor del 75% en la primera ronda de votación.
Objective
To determine reproducibility and validity of an Argentine version of the Lupus Quality of Life questionnaire (LupusQoL) and to determine cut-off values in the questionnaire.
Materials and ...methods
One hundred and forty-seven systemic lupus erythematosus patients (American College of Rheumatology 1982/1997) were assessed from April 2014 to July 2014. Demographic and socioeconomic variables were collected, as well as SELENA/SLEDAI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index Score, comorbidities and treatment data. Patients completed LupusQoL-Argentine version and European Quality of Life Questionnaire (EuroQoL-5D). Internal consistency and reliability were examined. Convergent validity with EuroQoL-5D was assessed through analysis of latent classes, which established homogeneous categories from the responses of each domain of LupusQoL and for the total.
Results
Out of 147 patients, 93.2% were female, mean age 36.4 ± 11.1 years, mean disease duration 2.7 ± 9 years, mean SELENA/SLEDAI 2.7 ± 3 points. The cut-off point that defined good or bad quality of life was 0.739 for EuroQoL 5D and 63 for LupusQoL. Cut-off values for each LupusQoL domain were also defined, creating two classes in each of them. There was moderate to high concordance to classify quality of life (Kappa = 0.74, 95% confidence interval = 0.54, 0.95).
Conclusion
The Argentine version of LupusQoL is a valid, reliable and reproducible instrument to assess quality of life. In this study, cut-off points that allow the classification of patients regarding whether they have good or bad quality of life are established for the first time.
Presently under construction in Lund, Sweden, the European Spallation Source (ESS) will be the world’s brightest neutron source. As such, it has the potential for a particle physics program with a ...unique reach and which is complementary to that available at other facilities. This paper describes proposed particle physics activities for the ESS. These encompass the exploitation of both the neutrons and neutrinos produced at the ESS for high precision (sensitivity) measurements (searches).
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