[Predictive factors of 2009 H1N1 virus infection in patients with influenza syndrome]. / Factores predictivos de infección por el virus de la gripe H1N1 2009 en pacientes con síndrome gripal.

INTRODUCTION: Polymerase chain reaction (PCR) testing is one of the better techniques for viral detection in nasopharyngeal swabs. The objective of this study was to assess the percentage of positive swabs and to determine whether there were differences according to PCR positivity. MATERIAL AND METHODS: A retrospective study of 362 patients with flu syndrome attended at the Emergency Department between July 15 and December 15, 2009, in whom PCR of nasopharyngeal swabs for the detection of H1N1 2009 influenza virus was performed. Those cases in which swab testing was adequately requested were identified, and patients were divided into two groups according to positive or negative results for H1N1 2009 influenza virus. RESULTS: Nasopharyngeal swab was inadequately ordered in 87. In the remaining 275 patients, PCR was positive in 141. Patients with positive nasopharyngeal swabs were younger (mean [SD] age 36.1 [15] vs 42.3 [18] years, P= 0.002), had lower white blood cell, neutrophil and lymphocyte counts, lower serum concentrations of C-reactive protein (5.15 [5] vs 10.5[12] mg/dL, P= 0.036) and lower incidence of radiological infiltrates (20.5% vs 33%, P= 0.036). In the logistic regression analysis, age, serum C-reactive protein levels, and lymphocyte count were independently associated with a positive nasopharyngeal swab. CONCLUSIONS: About 50% of patients with flu syndrome had positive nasopharyngeal swabs for H1N1 2009 influenza virus. Age, C-reactive protein, and lymphocyte count were independent predictors of positivity.

[Calcaneous ultrasonography as measurement of osteoporosis prevalence in the general population in relation to the diagnostic criterion utilized. Data of the study GIUMO]. / Prevalencia de osteoporosis en la población española por ultrasonografía de calcáneo en función del criterio diagnóstico utilizado. Datos del estudio GIUMO.

CONTEXT: In recent years, a large number of techniques have been developed to estimate the bone mineral density for the diagnosis of osteoporosis. However, diagnostic criteria established by WHO are invariably applied for the interpretation of dual radiological densitometry (DEXA), which could not be correct in the case of the interpretation of ultrasound. METHOD: We studied 2,589 randomly chosen people of both sexes, 1,138 males and 1,451 women from 10 to 99 years, in 11 spanish provinces. We carried out a measurement of the following calcaneous ultrasound parameters with the Sahara and Hologic devices: speed of the sound (SOS), coefficient of attenuation of wide band (BUA), index of consistency (QUI) and estimated bone mineral density (est. BMD). The prevalence of osteopenia and osteoporosis was calculated by applying the WHO criteria (osteopenia Tscore < or = 1 and osteoporosis Tscore < or = 2.5) and the prevalence of osteoporosis by applying a Tscore 1.8 as threshold. RESULTS: According to the WHO criteria, osteoporosis (Tscore < or = 2.5) is seen in 1.5 % males and 5.9 % females from 51 to 70 years, and in 2.6% males and 22.1% females over 70 years. Using a Tscore 1.8 as threshold, osteoporosis prevalence increases to 8.2% males and 21.9% females from 51 to 70 years, and to 8.4% males and 40.9% females over 70 years. CONCLUSION: Osteoporosis prevalence in spanish people of both sexes differs notably when applying the cut off point in a Tscore of 2.5, as WHO recommends, or in a Tscore of 1.8 as is suggested by other authors. Consensus is necessary to establish the appropriate cut off point or threshold for the diagnosis of osteoporosis with quantitative ultrasonography of calcaneum.

[Estimate of the costs of osteoporotic fractures of the femur in Spain]. / Aproximación a los costes de la fractura osteoporótica de fémur en España.

To evaluate the economic impact of osteoporosis, the cost of acute attention to the osteoporotic hip fractures recorded in Barcelona during one year was investigated. The hospital records of 8637 beds (85.64% of the overall number in the city) were reviewed and the cases seen in inhabitants aged 45 years or more during 1984 were included. The cost, days of hospital admission, operations and orthopedic material were recorded. Data from 870 fractures were recovered. During the study period 1358 hip fractures took place in Barcelona, with 1269 +/- 21 (mean +/- SEM) operations, 31219 +/- 1550 (mean +/- SEM) days of hospital admission, and 408 +/- 40 (mean +/- SEM) prostheses. Their attention generated a cost amounting to 662.5 +/- 29.5 (mean +/- SEM) million pesetas. The cost of each fracture was 488200 +/- 331700 (mean +/- SD) pesetas, with a hospital stay of 23 +/- 17 (mean +/- SD) days. This represents, for the whole of Spain, 33298 +/- 1769 (mean +/- SEM) fractures, 31160 +/- 2154 (mean +/- SEM) operations, 767853 +/- 78314 (mean +/- SEM) hospital admission days and 10042 +/- 1530 (mean +/- SEM) prostheses every year. The yearly expenditure is 16295 +/- 1598 (mean +/-SEM) million pesetas (confidence interval of the estimation 95%). Thus, osteoporotic hip fracture results in a significant expenditure in this country. The enormous cost of the attention to osteoporosis and its complications warrants a greater effort for its prevention and care.