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Imidacloprid (IDP) is an active ingredient of the Admire brand pesticide used to control the vector (Asian citrus psyllid) that transmits the causative organism Candidatus Liberibacter asiaticus (CLas) for citrus greening or huanglongbing disease. Imidacloprid products are applied via soil drench where citrus roots are mostly concentrated which is between 0 and 60 cm depth. These soil depths exhibit different characteristics that may affect IDP leaching beyond the rooting zone. Representative soil samples were collected from Entisols and Ultisols, which are the dominant soil orders under citrus production in central Florida, at 15 cm increments up to 60 cm to estimate and understand the batch sorption, kinetics, equilibria, and degradation of IDP. Results showed that the equilibrium time for IDP at 0-15 cm depth (10 hours) was 2 times faster than at 15-60 cm (20 hours) for the Entisol. Nevertheless, all depths reached equilibrium within 24 hours for the Entisol. The 0-30 cm depth adsorbed 2 times more IDP than the 30-60 cm depth for both soils. Nevertheless, the adsorption coefficient was approximately ≤ 1 mL g-1 for both soils. The half-life of IDP in both soils ranged from 10 to 17 days. The Entisol showed higher adsorption than the Ultisol at both depths, probably due to relatively lower organic carbon (OC) content in the Ultisol compared to the Entisol. Thus, the Ultisol showed high IDP leaching vulnerability compared to the Entisol. Movement of IDP is affected by the amount of OC in the citrus critical zone.
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Citrus , Neonicotinoides , Nitrocompuestos , Contaminantes del Suelo , Suelo , Neonicotinoides/química , Neonicotinoides/metabolismo , Nitrocompuestos/química , Nitrocompuestos/metabolismo , Florida , Suelo/química , Adsorción , Contaminantes del Suelo/química , Contaminantes del Suelo/metabolismo , Citrus/química , Cinética , Semivida , Insecticidas/química , Insecticidas/metabolismo , Imidazoles/química , Imidazoles/metabolismoRESUMEN
Huanglongbing (HLB) disease has caused a severe decline in citrus production globally over the past decade. There is a need for improved nutrient regimens to better manage the productivity of HLB-affected trees, as current guidelines are based on healthy trees. The aim of this study was to evaluate the effects of different fertilizer application methods and rates with different planting densities on HLB-affected citrus root and soil health. Plant material consisted of 'Ray Ruby' (Citrus × paradisi) grapefruit trees grafted on 'Kuharske' citrange (Citrus × sinensis × Citrus trifoliata). The study consisted of 4 foliar fertilizer treatments, which included 0×, 1.5×, 3× and 6× the University of Florida Institute of Food and Agriculture (UF/IFAS) recommended guidelines for B, Mn and Zn. Additionally, 2 ground-applied fertilizer treatments were used, specifically controlled-release fertilizer (CRF1): 12-3-14 + B, Fe, Mn and Zn micronutrients at 1× UF/IFAS recommendation, and (CRF2): 12-3-14 + 2× Mg + 3× B, Fe, Mn and Zn micronutrients, with micronutrients applied as sulfur-coated products. The planting densities implemented were low (300 trees ha-1), medium (440 trees ha-1) and high (975 trees ha-1). The CRF fertilizer resulted in greater soil nutrient concentrations through all of the time sampling points, with significant differences in soil Zn and Mn. Grapefruit treated with ground-applied CRF2 and 3× foliar fertilizers resulted in the greatest bacterial alpha and beta diversity in the rhizosphere. Significantly greater abundances of Rhizobiales and Vicinamibacterales were found in the grapefruit rhizosphere of trees treated with 0× UF/IFAS foliar fertilizer compared to higher doses of foliar fertilizers.
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With huanglongbing (HLB) causing a reduction in fine root mass early in disease progression, HLB-affected trees have lower nutrient uptake capability. Questions regarding the uptake efficiency of certain fertilizer application methods have been raised. Therefore, the goals of this study are to determine if nutrient management methods impact nutrient translocation and identify where in the tree nutrients are translocated. Destructive nutrient and biomass analysis were conducted on field grown HLB-affected grapefruit trees (Citrus × paradisi) grafted on 'sour orange' (Citrus × aurantium) rootstock under different fertilizer application methods. Fertilizer was applied in the form of either 100% soluble granular fertilizer, controlled release fertilizer (CRF), or liquid fertilizer. After three years, the entire tree was removed from the grove, dissected into eight different components (feeder roots, lateral roots, structural roots, trunk, primary branches, secondary branches, twigs, and leaves), weighed, and then analyzed for nutrient contents. Overall, application methods showed differences in nutrient allocation in leaf, twig, and feeder root; however, no consistent pattern was observed. Additionally, leaf, twig, and feeder roots had higher amount of nutrients compared to the other tree components. This study showed that fertilization methods do impact nutrient contents in different components of HLB-affected trees. Further research should be conducted on the impact of different fertilizer application methods and rates on HLB-affected trees.
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Citrus greening (huanglonbing (HLB)) disease has drastically reduced citrus fruit production in Florida over the last two decades. Scientists have developed sustainable nutrient management practices to live with the disease and continue fruit production. Best pesticide management practices have been devised to reduce the spread of HLB by Asian citrus psyllid (ACP). However, soil application of excessive nutrients and the use of soil drench application of pesticides to huanglongbing-infected citrus groves have been a serious environmental concern since the recent development of resistance to some pesticides. It is important to understand the consequences of applying pesticides and nutrients beyond the recommended application rates with an inappropriate method for citrus growth and development. Alternatively, foliar sprays of some nutrients proved effective to meet plants' requirements, and foliar sprays of effective insecticide products could provide an adequate mode of action for group rotation to minimize insecticide resistance by ACP and other pests. Sustainability in citrus production systems should include best management practices that improve pesticide and nutrient efficiency by including the total maximum daily load exiting the grove to reduce pesticide and nutrient exports into waterbodies.
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Solute fate in soil-plant continuum could either be soil or leaf uptake or leaching beyond the rooting zone. An adsorption coefficient (KD) is an important chemical property to describe the interaction between the solute and soil, affecting the solute movement in soils from one point to another. Boron (B), manganese (Mn), and zinc (Zn) uptake are evident in the leaves as a constituent of photosynthesis and other plant body-building mechanisms for growth and development. This study investigates the availability of micronutrients (B, Mn, and Zn) to citrus trees through modified application methods and rates. Leaf samples were collected from experimental plots arranged in a randomized complete block design, with 4 micronutrient treatments: control, foliar ×1, foliar ×2, and soil ×1. Boron, Mn, and Zn rates were 1.12, 10.08, and 5.60 kg ha-1, respectively. Composite soil samples were randomly collected at 5 points, and a 1-point adsorption study was conducted in 4 soil depths at an increment of 15 cm from the soil surface. Adsorption coefficient (KD) for Mn and B was 22 and 3 times higher at 0-15 cm than at soil depth of 15-60 cm. The adsorption coefficient (KD) for Zn was 2.5 times greater at 0-15 cm than 15-30 cm soil depth, while there was little or no sorption at 30-60 cm. Leaf Mn and Zn concentrations showed that foliar spray was 2 times higher than the soil application method, while B showed that the soil application method was 2 times higher than foliar application method for 2 seasons sampling events. Thus, the behavior of B, Mn, and Zn in the soil via adsorption coefficient (KD) reflects the availability of B, Mn, and Zn in the citrus leaves.
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Enhanced nutritional programs (ENPs) have improved citrus trees' growth and development in the era of Huanglongbing (HLB). Studies conducted with variable rates of manganese (Mn) and Iron (Fe) on young HLB-affected citrus trees showed that applying double the standard recommendation increased growth and biomass accumulation. Since HLB is believed to cause deficiency symptoms of micronutrients in citrus trees, it is critical to ensure their optimal levels in the leaves. This could be achieved by soil application of either a Mn rate of 8.9 to 11.5 kg ha-1 as MnSO4 (31%) for young HLB-affected 'Valencia' (Citrus sinensis (L.) Osbeck) citrus trees or an Fe rate of 9.6 to 11.8 kg ha-1 as Ferrous sulfate heptahydrate (20%) for 'Bingo' (Citrus reticulata, Blanco) citrus trees. Maintaining optimal levels of these micronutrients may enable citrus trees to carry out photosynthetic activities to ensure growth and development. It may also help the tree in the regulation of various physiological processes as part of the antioxidant enzyme Mn-superoxidase dismutase (SOD). Micronutrient manipulation through variable rates of fertilizer application to influence nutrient availability is an important mitigating factor for HLB-affected citrus trees and an integral component of citrus production in Florida.
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The fate of foliar and ground-applied essential nutrients is the least studied topic under citrus greening or Huanglongbing (HLB)-affected citrus, which is inherently suffering from severe root decline because of HLB-associated problems. The objective of this study was to evaluate if ground-applied coupled with foliar spray of essential nutrients can reverse the decline in tree growth and understand the fate of the nutrients in the soil-root-tree interfaces. The treatments were arranged in a split-split plot design in which nitrogen (N) was ground-applied in 20 splits biweekly and Mn, Zn, and B were foliar and /or ground-applied in three splits following the spring, summer, and late summer flush seasons. Soil nutrients in three depths (0-15, 15-30, and 30-45 cm), root, and leaf nutrient concentrations of the essential nutrients, leaf area index (LAI), and tree canopy volume (TCV) data were studied twice (spring and summer) for two years. A significantly higher soil NH4-N and NO3-N concentrations were detected in the topsoil depth than the two lower soil depths (15-30 and 30-45 cm) indicating lesser nutrient leaching as trees received moderate (224 kg ha-1) N rate. Except for soil zinc (Zn) concentration, all the nutrient concentrations were significantly higher in the topsoil (0-15 cm), compared with two lower soil depths indicating that Zn was intricate by changes in soil environmental conditions, root acquisition, and/or leaching to lower soil depth. Leaf N concentration significantly increased over time following seasonal environmental fluctuations, tree growth, and development. Thus, leaf N concentration remained above the optimum nutrient range implying lower N requirement under irrigation scheduling with SmartIrrigation, an App used to determine the daily irrigation duration to meet tree water requirement and split fertigation techniques. Root Manganese (Mn) and Zn concentrations were significantly higher in the root tissues of the treated than the control trees and translocated to the leaves accordingly. Meanwhile, a significantly higher LAI for trees budded on Swingle (Swc) rootstock however, larger TCV for trees budded on Volkameriana (Volk) rootstocks. The trees had significantly larger TCV when the trees received a moderate N rate during early study years and under foliar 9 kg ha-1 coupled with the ground 9 kg ha-1 Mn and Zn treatments during the late study years. Therefore, split ground application of 224 kg ha-1 of N, foliar applied 9 kg ha-1 coupled with ground-applied 9 kg ha-1 Mn and Zn were the suggested rates to sustain the essential leaf nutrient concentration within the optimum ranges and improve the deterioration of vegetative growth associated with HLB-induced problems of citrus trees.
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INTRODUCTION: Capsule endoscopy (CE) is well established the investigation of small-bowel (SB) pathology. We compared the use of double-headed (DH) capsules, to conventional single-headed (SH), in a real-world patient cohort in the first multicentre British study. METHODS: Over 9 months, patients referred for routine SBCE at 4 tertiary referral centres in the UK underwent DH CE instead of conventional SH using MiroCamâ MC2000 as per local protocols. One head (L/R) was chosen at random and reported by an expert reviewer. The DH recordings, anonymised and randomised, reported by another expert or re-read after a 4-week interval. For each CE, numbers and types of findings and overall conclusion/diagnosis were compared between SH and DH examinations. RESULTS: 211 CEs were performed. 7 failed to reach the SB; 204 analysed. Indications were: SB bleeding (nâ¯=â¯94); ?SB inflammation or reassessment of known inflammatory bowel disease (IBD) (nâ¯=â¯84); ?SB neoplasia including suspicious radiological imaging (nâ¯=â¯15); and, others e.g. ?celiac disease (nâ¯=â¯11). For SB bleeding: 27/94 (28.7%) examinations reported differences between SH and DH readings. In 17 (18.1%) the findings were clinically significant. SH CE missed angiectasias (5 pts), SB inflammation (7 pts), oesophagitis (2 pts) and SB masses (2 pts). In 1 patient, the extent of angiectasias seen was greater on the DH reading. For IBD: findings differed in 30/84 (35.7%) of CEs; 11 (13.1%) were clinically significant. In 5, signs of active inflammation were missed by the SH reading. In 6, assessment of extent/severity differed. For?SB neoplasia findings differed in 2/15 (13.3%) of examinations. Both were clinically significant. For others: 1/11 (9.1%) examinations differed; however, not deemed clinically significant. Overall, use of DH CE impacted the diagnosis in 30/204 (14.7%). CONCLUSIONS: The use of DH CE provides more information with the potential to change clinical diagnosis and therefore management. Therefore, the routine adoption of DH CE in SB assessment should be considered.
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Endoscopía Capsular , Hemorragia Gastrointestinal/diagnóstico , Enfermedades Inflamatorias del Intestino/diagnóstico , Neoplasias Intestinales/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Enfermedades Inflamatorias del Intestino/patología , Neoplasias Intestinales/patología , Intestino Delgado/diagnóstico por imagen , Estudios Retrospectivos , Reino UnidoAsunto(s)
COVID-19 , Pandemias , Femenino , Humanos , Embarazo , Estándares de Referencia , SARS-CoV-2 , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: To explore the modifications to maternity services across the UK, in response to the coronavirus disease 2019 (COVID-19) pandemic, in the context of the pandemic guidance issued by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and NHS England. DESIGN: National survey. SETTING: UK maternity services during the COVID-19 pandemic. POPULATION OR SAMPLE: Healthcare professionals working within maternity services. METHODS: A national electronic survey was developed to investigate local modifications to general and specialist maternity care during the COVID-19 pandemic, in the context of the contemporaneous national pandemic guidance. After a pilot phase, the survey was distributed through professional networks by the RCOG and co-authors. The survey results were presented descriptively in tabular and graphic formats, with proportions compared using chi-square tests. MAIN OUTCOME MEASURES: Service modifications made during the pandemic. RESULTS: A total of 81 respondent sites, 42% of the 194 obstetric units in the UK, were included. They reported substantial and heterogeneous maternity service modifications. Seventy percent of units reported a reduction in antenatal appointments and 56% reported a reduction in postnatal appointments; 89% reported using remote consultation methods. A change to screening pathways for gestational diabetes mellitus was reported by 70%, and 59% had temporarily removed the offer of births at home or in a midwife-led unit. A reduction in emergency antenatal presentations was experienced by 86% of units. CONCLUSIONS: This national survey documents the extensive impact of the COVID-19 pandemic on maternity services in the UK. More research is needed to understand the impact on maternity outcomes and experience. TWEETABLE ABSTRACT: A national survey showed that UK maternity services were modified extensively and heterogeneously in response to COVID-19.
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COVID-19 , Servicios de Salud Materna , Innovación Organizacional , Citas y Horarios , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Encuestas de Atención de la Salud , Fuerza Laboral en Salud , Hospitalización/estadística & datos numéricos , Humanos , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/normas , Servicios de Salud Materna/tendencias , Guías de Práctica Clínica como Asunto , Embarazo , Consulta Remota/estadística & datos numéricos , SARS-CoV-2 , Medicina Estatal/tendencias , Reino Unido/epidemiologíaRESUMEN
Understanding citrus tree root development and dynamics are critical in determining crop best nutrient management practices. The role of calcium (Ca) and magnesium (Mg), manganese (Mn), Zinc (Zn), and boron (B) on huanglongbing (HLB) affected citrus trees' root growth and lifespan in Florida is not fully documented. Thus, the objective of this study was to determine the impact of foliar and ground-applied essential nutrients on seasonal fine root length density (FRLD; diameter (d) < 2 mm) and coarse roots (d > 2 mm), FRLD dynamics, root survival probability (lifespan), and root-zone soil pH of HLB-affected sweet orange trees. Results indicated that Ca treated trees budded on Cleopatra (Cleo) and Ca and Mg combined treatments on Swingle (Swc) rootstocks significantly increased seasonal FRLD of fine (< 2 mm) and coarse roots. The highest median root lifespan of Ca treated trees was 325 and 339 days for trees budded on Cleo and Swc rootstocks, respectively. In the second study, the coarse roots showed a significantly higher reaction to the nutrition applied than the fine roots. Meanwhile, the 2× (1× foliar and 1× ground-applied) treated trees showed a significantly higher median root lifespan compared to the other treatments. Thus, the current study unwraps future studies highlighting the combined soil and/or foliar application of the above nutrients to stimulate FRLD and improve root lifespan on HLB-affected sweet oranges with emphasis on root-zone soil pH.
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Leaching of irrigation water from blueberry (Vaccinium spp.) plants intensifies when sandy soils are amended with pine (Pinus spp.) bark. In a greenhouse study, leaching fractions of water (LFW) and nutrients (LFN) were determined from two blueberry (V. corymbosum L.) cultivars, 'Emerald' and 'Jewel', grown in biochar-treated and nontreated sandy subsoil and irrigated with drip emitters using one of three pulse frequencies in a factorial design. The LFW was >50% under Emerald and <20% under Jewel, which has a more extensive root system. When the frequency of same volume of irrigation was increased from 2 (F2) to 10 (F10) pulses per day, the average LFW decreased from 46 to 30%. The LFN from a single fertigation was much lower than the total LFN after 6 d of irrigations applied between two fertigation events. The LFN increased linearly with LFW. Amending subsoil with 2% biochar increased soil pH, limited root growth, and did not reduce nutrient leaching. Eighteen months after plant establishment, 1.9% of applied NO3 --N and 2.5% of applied PO4 3--P from Emerald and 0.8 and 1.0%, respectively, from Jewel leached below the root zone during a fertigation event. During irrigations following a fertigation event, 10.5% of both NO3 --N and PO4 3--P from Emerald and 3.0 and 2.5% from Jewel leached below the root zone. All growth parameters including root/shoot ratio were higher in Jewel than Emerald. This study indicated that leaching rates could be reduced by selecting blueberry cultivars with a dense root system and using a drip irrigation system with >5 pulses d-1 to supply the daily water requirements in pine bark-amended sandy soil.
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Arándanos Azules (Planta) , Pinus , Corteza de la Planta , Arena , SueloRESUMEN
Models help to describe and predict complex processes and scenarios that are difficult to understand or measure in environmental management systems. Thus, model simulations were performed (i) to calibrate HYDRUS-2D for water and solute movement as a possible decision support system for Candler and Immokalee fine sand using data from microsprinkler and drip irrigation methods, (ii) to validate the performance of HYDRUS-2D using field data of microsprinkler and drip irrigation methods, and (iii) to investigate Br, NO, and water movement using annual or seasonal weather data and variable fertigation scenarios. The model showed reasonably good agreement between measured and simulated values for soil water content ( = 0.87-1.00), Br ( = 0.63-0.96), NO-N ( = 0.66-0.98), P ( = 0.25-0.78), and K ( = 0.44-0.99) movement. The model could be successfully used for scheduling irrigation and predicting nutrient leaching for both microsprinkler and drip irrigation systems on Florida's sandy soils.
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Monitoreo del Ambiente/métodos , Modelos Químicos , Nitrógeno/análisis , Fósforo/análisis , Contaminantes del Suelo/análisis , Movimientos del Agua , Contaminantes Químicos del Agua/análisis , Riego Agrícola , Agricultura/estadística & datos numéricos , Fertilizantes , Florida , SueloRESUMEN
Imidacloprid (IMD) is a neonicotinoid pesticide soil-drenched to many crops to control piercing-sucking insects such as the Asian citrus psyllid (ACP). Neonicotinoids are persistent in the environment and transport analyses are helpful estimate leaching potential from soils that could result in groundwater pollution. The objective of this study was to analyze IMD breakthrough under saturated water flow in soil columns packed with three horizons (A, E, Bh) of Immokalee Fine Sand (IFS). Also, we used the dimensionless form of the convective-dispersive model (CD-Model) to compare the optimized transport parameters from each column experiment (retardation factor, R; fraction of instantaneous-to-total retardation, ß; and mass transfer coefficient, ω) with the parameters obtained from sorption batch equilibria and sorption kinetics. The tracer (Cl-) breakthrough curves (BTCs) were symmetrical and properly described by the CD-Model. IMD BTCs from A, Bh, and multilayered [A+E+Bh] soil columns showed steep fronts and tailing that were well described by the one-site nonequilibrium (OSNE) model, which was an evidence of non-ideal transport due to IMD mass transfer into the soil organic matter. In general, IMD was weakly-sorbed in the A and Bh horizons (R values of 3.72 ± 0.04 and 3.08 ± 0.07, respectively), and almost no retardation was observed in the E horizon (R = 1.20 ± 0.02) due to its low organic matter content (0.3%). Using the HYDRUS-1D package, optimized parameters (R, ß, ω) from the individual columns successfully simulated IMD transport in a multilayered column mimicking an IFS soil profile. These column studies and corresponding simulations agreed with previous findings from batch sorption equilibria and kinetics experiments, where IMD showed one-site kinetic mass transfer between soil surfaces and soil solution. Ideally, sandy soils should be maintained unsaturated by crop irrigation systems and rainfall monitoring during and after soil-drench application. The unsaturated soil will increase IMD retardation factors and residence time for plant uptake, lowering leaching potential from soil layers with low sorption capacity, such as the E horizon.
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Imidazoles/química , Insecticidas/química , Nitrocompuestos/química , Contaminantes del Suelo/química , Suelo/química , Contaminantes Químicos del Agua/química , Cinética , Modelos Teóricos , Neonicotinoides , Movimientos del AguaRESUMEN
Routine DXA scanning in a 68-year-old asymptomatic man undergoing long-term bisphosphonate treatment for osteogenesis imperfecta showed unexplained loss of bone mineral density in two lumbar vertebrae. Subsequent radiographs revealed a 14-cm abdominal aortic aneurysm eroding the vertebrae. The importance of reviewing all the vertebrae in DXA scans is emphasized, and reasons for the absence of symptoms suggested.
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Aneurisma de la Aorta Abdominal/complicaciones , Vértebras Lumbares/diagnóstico por imagen , Osteogénesis Imperfecta/complicaciones , Osteoporosis/etiología , Absorciometría de Fotón , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Densidad Ósea/efectos de los fármacos , Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Humanos , Masculino , Osteogénesis Imperfecta/tratamiento farmacológico , Osteogénesis Imperfecta/fisiopatología , Osteoporosis/diagnóstico por imagen , Osteoporosis/fisiopatología , PamidronatoRESUMEN
BACKGROUND: Bisphosphonates (BP) have been associated with osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF). The prevalence of these side effects in intravenous (IV) BP-treated subjects is not well understood. AIM: This audit aimed to delineate the prevalence of ONJ, thigh pain and AFF in patients having regular IV BP and its effect on bone mineral density (BMD). Design and METHODS: Patients attending for IV BP over a 3-month period completed a questionnaire about thigh pain and dental health. Data concerning BMD, treatment indication and treatment history were obtained from medical records. RESULTS: There were 201 patients between 28 and 94 years (74.1% female) mostly on zoledronate (ZOL) (102) or pamidronate (PAM) (97). Osteoporosis (75.6%) and Paget's disease (16.5%) were the main indications for treatment; median length of IV BP was 4 years (range 0.25-25). One patient had ONJ (0.5%) while oral pain was reported by 6.5% and 12.7% noted tooth loosening. Twenty-seven subjects (13.4%) complained of current thigh pain. AFF occurred in four patients (2%), none of whom had idiopathic osteoporosis. At time of AFF, only one patient had a femoral neck T-score less than -2.5. All four had received pamidronate treatment; median 12.5 years (range 7-22). IV BP treatment significantly increased lumbar spine BMD but not femoral neck BMD. CONCLUSION: Classical ONJ was rare (0.5%), although tooth loss was more frequent. Thigh pain was frequent while AFF occurred in 2.0% of subjects and was associated with long treatment periods and non-osteoporotic bone.
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Osteonecrosis de los Maxilares Asociada a Difosfonatos/epidemiología , Enfermedades Óseas/tratamiento farmacológico , Difosfonatos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Fracturas del Fémur/epidemiología , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Osteonecrosis de los Maxilares Asociada a Difosfonatos/fisiopatología , Conservadores de la Densidad Ósea/administración & dosificación , Conservadores de la Densidad Ósea/efectos adversos , Enfermedades Óseas/clasificación , Enfermedades Óseas/etiología , Difosfonatos/administración & dosificación , Difosfonatos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/clasificación , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Fracturas del Fémur/inducido químicamente , Disparidades en el Estado de Salud , Humanos , Incidencia , Masculino , Auditoría Médica , Persona de Mediana Edad , Farmacovigilancia , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Reino Unido/epidemiologíaRESUMEN
To review whether osteoporosis in the absence of vertebral fracture (VFX) affects health-related quality of life (HRQoL), a systematic search of the main literature databases for HRQoL in patients with osteoporosis without VFX was undertaken. This was undertaken. This identified 1,327 articles as potentially relevant to the review. After screening of abstracts and reviewing 168 articles in detail, 27 were considered relevant. HRQoL data were extracted and collated into tables and, where possible, were converted into normative scores and further analysed. Data relating to the associations between HRQoL and bone mineral density (BMD) were also collated. Of the 27 articles included, only 5 directly compared osteoporosis without VFX with a control group (BMD T-score > -1.0, without VFX). Extracted raw data from 21 articles demonstrated that patients with osteoporosis without VFX had clinically relevant reductions in role physical, general health, vitality, mental health domains and the mental component summary score, using SF36. Using Qualeffo-41, pain and physical function were worse in these patients. Also, HRQoL was related to upper femur, but not lumbar spine BMD. HRQoL data in patients with osteoporosis without VFX are limited and variable but suggest that HRQoL is adversely affected by osteoporosis in the absence of VFX. The association of lower BMD and worse HRQoL suggests that more attention should be paid to HRQoL in those without VFX. Future studies are needed to investigate HRQoL in patients with osteoporosis in the absence of fracture, controlling for co-morbidities and social and economic status.