Cost of osteoporotic hip fracture in Spain per Autonomous Region. / Coste de la fractura de cadera osteoporótica en España por comunidad autónoma.

OBJECTIVE: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. METHODS: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. RESULTS: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). CONCLUSIONS: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits.

[Gastroparesis and other gastrointestinal symptoms in Parkinson's disease]. / Gastroparesia y otros sintomas gastrointestinales en la enfermedad de Parkinson.

Different gastrointestinal symptoms, such as excessive salivation, deterioration and other disorders affecting the teeth, dysphagia, gastroparesis, gastroesophageal reflux, constipation, difficult defecation or loss of weight are frequent events in all the stages of the development of Parkinson's disease and affect at least a third of the patients. These symptoms reflect the dysfunction of the enteric nervous system, and the stomach is one of the organs where alpha-synuclein is first deposited. Other factors, such as the dysfunction of structures in the central nervous system like the dorsal motor nucleus of the vagal nerve, hormonal factors or secondary effects deriving from the consumption of antiparkinsonian drugs, are involved in its origin. The present article offers a detailed review of the epidemiological, pathophysiological, clinical and therapeutic management aspects of the different gastrointestinal symptoms in Parkinson's disease.

TITLE: Gastroparesia y otros sintomas gastrointestinales en la enfermedad de Parkinson.Diferentes sintomas gastrointestinales, como salivacion excesiva, deterioro y otros trastornos de las piezas dentarias, disfagia, gastroparesia, reflujo gastroesofagico, estreñimiento, dificultades en la defecacion o perdida de peso, son frecuentes en todos los estadios evolutivos de la enfermedad de Parkinson y afectan al menos a un tercio de los pacientes. Estos sintomas reflejan la disfuncion del sistema nervioso enterico, siendo el estomago uno de los organos donde mas precozmente se deposita la alfa-sinucleina. Otros factores, como la disfuncion de estructuras del sistema nervioso central como el nucleo motor dorsal del nervio vago, factores hormonales o efectos secundarios derivados del consumo de farmacos antiparkinsonianos estan implicados en su origen. El presente articulo revisa en detalle aspectos epidemiologicos, fisiopatologicos, clinicos y de manejo terapeutico de los diferentes sintomas gastrointestinales en la enfermedad de Parkinson.

Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus.

Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high.

Consensus statement: recommendations for the management of metabolic bone disease in human immunodeficiency virus patients / Documento de consenso: Recomendaciones para el manejo de la enfermedad ósea metabólica en pacientes con virus de la inmunodeficiencia humana

"OBJECTIVE: To provide practical recommendations for the evaluation and treatment of metabolic bone disease in human immunodeficiency virus (HIV) patients. PARTICIPANTS: Members of scientific societies related to bone metabolism and HIV: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM), and Sociedad Española de Fractura Osteoporótica (SEFRAOS). METHODS: A systematic search was carried out in PubMed, and papers in English and Spanish with a publication date before 28 May 2013 were included. Recommendations were formulated according to GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) setting both their strength and the quality of supporting evidence. Working groups were established for each major part, and the final resulting document was later discussed in a face-to-face meeting. All the authors reviewed the final written document and agreed with its content. CONCLUSIONS: The document provides evidence-based practical recommendations on the detection and treatment of bone disease in HIV-infected patients"

"Objetivo Proporcionar unas recomendaciones prácticas para el manejo de la enfermedad metabólica ósea en pacientes con virus de la inmunodeficiencia humana (VIH). Participantes Miembros de diferentes sociedades científicas relacionadas con el metabolismo óseo y con la enfermedad VIH: Grupo de Estudio de Sida (GeSIDA), Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española de Investigación Ósea y del Metabolismo Mineral (SEIOMM) y Sociedad Española de Fractura Osteoporótica (SEFRAOS). Métodos Se realizó una búsqueda sistemática en PubMed de la evidencia disponible para cada aspecto, y se revisaron artículos escritos en inglés y en castellano con fecha de inclusión hasta 28 de mayo de 2013. Las recomendaciones se formularon según el sistema GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Los autores trabajaron por grupos en la formulación de cada apartado de las recomendaciones y posteriormente el documento global se discutió en una reunión conjunta. Todos los autores revisaron el documento escrito final y lo consensuaron. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y el tratamiento de la enfermedad metabólica ósea en pacientes con VIH"

[SECOT consensus on medial femorotibial osteoarthritis]. / Consenso SECOT artrosis femorotibial medial.

A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique.

Long-term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well-being.

BACKGROUND: Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson's disease (PD). However, in which aspects improve the patients their QoL has been poorly documented. METHODS: We evaluated 39-item Parkinson's disease Quality of Life Questionnaire Summary Index score (PDQ-39SI) changes analyzing its different domains in nine patients with advanced PD treated with DLI. RESULTS: All the patients (64.7 ± 11.1 years, 55.5% men) improved PDQ-39SI 6 months after beginning with DLI (29.7 ± 8.6, P = 0.008) and after median duration infusion of 25.3 ± 8.8 months (34.8 ± 11.2, P = 0.008) compared with baseline (55.6 ± 11.5). All domains except social support improved significantly at 6 months. Mobility (P = 0.012), activities of daily living (P = 0.015), and emotional well-being (P = 0.008) improved significantly at the end of the follow-up. CONCLUSIONS: DLI improves QoL in patients with advanced PD after short- and long-term exposure. Whereas all domains except social support improve after 6 months under DLI, only mobility, activities of daily living and emotional well-being improve significantly after long-term exposure to DLI.

Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer.

OBJECTIVES: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. PATIENTS AND METHODS: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. RESULTS: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). CONCLUSIONS: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.

[Low birth weight is a risk factor for type 1 diabetes]. / El bajo peso al nacer es un factor de riesgo de diabetes mellitus tipo 1.

INTRODUCTION AND AIM: Over recent years, the increasing incidence of type 1 diabetes mellitus (T1DM) has been associated with different factors, particularly increased obesity in childhood. The aim of this study was to find out if there was any relationship between birth weight, body mass index (BMI) increase during the first two 3 years of life, and BMI at diabetes onset with age at diagnosis, in a cohort of children diagnosed with T1DM. MATERIAL AND METHOD: Data from 100 Caucasian children with T1DM of both sexes (57 boys, 43 girls) between 10 months and 16 years of age, mean age 84.45 months (SD; 52.4), were studied. We analysed the following variables: age at diagnosis, gestational age, weight and height at birth, at two years of age and at diabetes diagnosis, expressed as SD scores (SDS). RESULTS: All children were between 38-40 weeks of gestational age. Diabetic patients have lower birth weight (-2.88 ((-0.51)-(-0.066)) and lower BMI at birth compared with healthy children -0.5 ((-0.77)-(-0.23)). Diabetic children have a significant increase in BMI during the first two years of life (4.58 versus 2.17; P<0.001). Children with the lowest BMI at birth (12.77 versus 13.06; P<0.006) are the youngest at onset of the disease. BMI at diagnosis was not related to any of the variables studied. There were no gender differences either. CONCLUSIONS: The low BMI at birth and the later increase in the following years of life seem to be related to intrauterine environment as a risk factor for T1DM.

Spontaneous collapse of the tibial plateau: radiological staging.

OBJECTIVE: This paper proposes a radiological staging system for necrosis of the tibial plateau, similar to those already developed for the hip and the medial femoral condyle. DESIGN AND PATIENTS: We retrospectively studied the clinical case histories and radiographic findings of 14 patients (15 affected knees) with histologically proven osteonecrosis of the tibial plateau. RESULTS: Stage I was marked by normal radiograph, but increased uptake in bone scan and subchondral areas of abnormal marrow signal intensity in magnetic resonance imaging (MRI), as reported in other osteonecrosis sites. Stage II was characterised by cystic and sclerotic changes, and stage III fracture of the medial rim of the medial tibial plateau and tibial plateau collapse were present. Stage IV was marked by joint narrowing. These changes appeared earlier and were more pronounced when there was genu varum/valgum or involvement of the lateral tibial plateau. CONCLUSIONS: The radiological evolution of the disease appears to follow a four-stage course over a period of roughly one year from the onset of symptoms.

Clinical features of ten cases of osteopoikilosis.

A retrospective study was carried out of the ten cases of osteopoikilosis seen at this Orthopedic Unit over a 15-year period in order to determine the reasons why patients seek consultation, preliminary diagnosis, and associated lesions. Eight patients consulted for problems not related to the locomotor apparatus, and diagnosis was by chance; the other two presented joint pain. The preliminary diagnosis was osteoblastic metastasis in five patients and osteopoikilosis in the other five. None of the patients displayed skin or visceral involvement, but three presented bone alterations. Definitive diagnosis was made by measurement of biochemical markers of bone remodeling, radiography of both hands, and bone scan. Bone biopsy was performed in one case. Although rare, the radiographic symptoms of osteopoikilosis are sufficiently specific to avoid false diagnoses, which may give rise to rigorous and expensive studies for other important disorders.

Stress fractures of the femoral neck and coxa vara.

BACKGROUND: Theoretically, coxa vara substantially modifies the biomechanical conditions of the femoral neck, increasing the effect of direct muscle pull and leading to fatigue of opposing muscle groups; such modifications would appear to favour the appearance of stress fractures. METHODS: We studied 22 stress fractures of the femoral neck, 12 in patients with coxa vara (group A) and 10 in patients with a normal neck-shaft angle (group B), to assess the possible influence of the femoral angle in the production of stress fractures. RESULTS: Intergroup differences were found for age at the appearance of the fracture (younger patients in the coxa vara group) and symptom duration (longer in group A). CONCLUSIONS: It is suggested that coxa vara predisposes to femoral neck stress-fracture.

Differential expression of thymosins beta(4) and beta(10) during rat cerebellum postnatal development.

The beta-thymosins are a family of actin monomer-sequestering proteins widely distributed among vertebrate classes. The most abundant beta-thymosins in mammalian species are thymosin beta(4) (Tbeta(4)) and thymosin beta(10) (Tbeta(10)), two small peptides (43 amino acids) sharing a high degree of sequence homology. In the present work, we have analyzed the distribution of Tbeta(4) and Tbeta(10) in the developing and adult rat cerebellum using in situ hybridization and immunohistochemistry techniques. Our results show that the temporal and cellular patterns of expression of both beta-thymosins are different. In the young (7 and 18 postnatal days) and adult (1 and 4 months old) rat cerebellum, Tbeta(4) was mainly expressed in the glia (microglia, Golgi epithelial cells and oligodendrocytes), neurons (granule cells and Purkinje cells), and in the capillaries. In 14-month-old rats, the Tbeta(4) immunoreactivity was only detected in some microglia cells. In young and adult animals, most of the Tbeta(10) immunoreactivity was localized in several types of neuronal cells including granule cells, Golgi neurons and Purkinje cells. In old animals, a faint Tbeta(10) signal could be detected in a few Purkinje cells. Our results suggest that each beta-thymosin could play a different function in the control of actin dynamics.

Expression of the thymosin beta10 gene in normal and kainic acid-treated rat forebrain.

Thymosin beta10 (Tbeta10) is a small actin-sequestering peptide widely distributed in mammalian tissues including nervous system. Here, we analyze the expression of Tbeta10 gene in normal and kainic acid (KA)-treated rat forebrain by in situ hybridization. Our results showed a defined regional pattern of the mRNA encoding for Tbeta10 in both normal and KA-treated rat forebrain. The presence of this transcript in different regions of the rat forebrain, including hippocampus, neocortex and several brain nuclei, provides evidence for the participation of Tbeta10 in the control of the actin dynamics that takes place in neurons. Furthermore, the analysis of the forebrain in KA-treated rats revealed an activation of the Tbeta10 gene linked to gliosis.

Expression of thymosin beta4 messenger RNA in normal and kainate-treated rat forebrain.

Thymosin beta4 is a major actin-sequestering peptide widely distributed in mammalian tissues, including the nervous system. In the present study, we analyse the expression of thymosin beta4 in normal and kainate-treated rat forebrain. In untreated animals, thymosin beta4 messenger RNA is mainly expressed in neurons of the hippocampal formation, neocortex and amygdaloid complex, as well as in oligodendrocytes. Other high-expressing areas are the tanycytic ependyma of the infundibulum, the substantia nigra pars compacta, and the supraoptic and premammillary nuclei. In rats treated with kainate, an excitotoxin that induces synaptic activation in the CA1-CA3 pyramidal neurons of the hippocampus, the levels of thymosin beta4 were clearly increased in the hippocampus and neocortex during the first 2-3 h after injection. In the long term, kainate causes neuronal degeneration in the CA1-CA3 regions of the hippocampus and functionally related structures, provoking a depletion of thymosin beta4 messenger RNA in these areas; however, the levels of this transcript are restored two weeks after kainate injection. Moreover, we have found that, in these degenerating zones, gliosis is accompanied by an elevation of the levels of thymosin beta4 messenger RNA, particularly in the CA1-CA3 region of the hippocampus, the lateral geniculate nucleus and the mammillothalamic tract. The present results demonstrate the existence of relatively high levels of thymosin beta4 messenger RNA in several areas of the rat forebrain, indicating that this peptide plays an important role in the regulation of actin polymerization in these regions of the brain. Moreover, the elevation of this messenger RNA after kainate treatment suggests a function of thymosin beta4 in the production and remodelling of neuronal processes. Finally, our findings provide evidence for a participation of this actin-sequestering molecule in the reactivity of certain types of glial cell that follows kainate lesions.

Progression of bone lesions in cured leprosy patients.

A group of 52 patients deemed to be cured of Hansen's disease were examined in order to determine the appearance or aggravation of bone lesions after cure. A study was made of X-rays performed both at the moment these patients were considered to be cured and a minimum of 2 years later. During the elapsing interval, new lesions had appeared in 8 patients, and existing lesions had worsened in 12 patients. Factors associated with the progression of lesions were: impaired sensitivity, physical activity and appearance of plantar ulcers. The authors feel that leprosy patients, even when considered to be bacteriologically cured, should undergo regular checkups. Factors which might aggravate bone lesions should be borne in mind.

Bone island and leprosy.

OBJECTIVE: To determine the incidence of bone islands in leprosy patients. DESIGN: X-rays of feet and hands of patients with Hansen's disease (leprosy) were reviewed retrospectively. A second group of related age- and sex-matched patients who did not have Hansen's disease was used for control purposes. Controls had undergone hand and foot X-rays during diagnosis of other pathologies. The patients with Hansen's disease were compared with the control groups, and were also analyzed as subgroups with different types of leprosy. The results were subjected to statistical analysis. PATIENTS: Ninety patients with Hansen's disease were randomly selected for this study. Patients who had had ulcers on hands or feet were excluded from the study. RESULTS AND CONCLUSIONS: Bone islands were demonstrated in 20 patients with Hansen's disease; no bone islands were observed in the controls. This was statistically significant (P < 0.01). Bone islands were only seen in patients with lepromatous leprosy and borderline types but were not demonstrated in patients with tuberculoid leprosy. There was also a statistically significant relationship for a disease duration of 15 years or more. The cause of this raised incidence of enostosis in leprosy patients is not clear, but there may be a genetic predisposition in patients with leprosy, or it may be a side effect of leprosy, especially the lepromatous form.