[Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain]. / Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso.

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥7 for each recommendation (1=total disagreement to 10=total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain.

Clinical evidence of diabetes mellitus end-organ damage as risk factor for falls complicated by hip fracture: A multi-center study of 1225 patients.

AIMS: To identify the differential characteristics of patients with type 2 diabetes mellitus (T2DM) complicated by end-organ damage who experience a fall-related hip fracture. METHODS: We analyzed the socio-demographic data and index fall clinical characteristics of a group of patients with nephropathy, neuropathy or retinopathy related to T2DM consecutively admitted to six hospitals in Barcelona, Spain because of a fall-related hip fracture. RESULTS: Out of 1225 patients admitted because of a fall-related hip fracture, 107 (8.7%) had clinical evidence of end-organ damage related to T2DM. Among this cohort the mean number of falls during the year prior to the index admission was 2.6±3.2; and 29 of them (27.1%) had already experienced three or more falls. Most falls leading to the index admission took place at the patients' home, from a standing position, and during daylight time. An intrinsic cause of falling was identified in all but one of these patients. Multiple stepwise logistic regression analysis showed that, compared to patients without this diagnosis, patients with complicated T2DM were younger (odds ratio 0.762), had less prevalence of dementia (odds ratio 0.078), but had experienced a higher number of falls in the previous year (odds 1.183). CONCLUSIONS: A significant amount of patients with clinical evidence of end-organ damage due to T2DM who experience a fall-related hip fracture have a history of recurrent falling in the previous year. These patients should be identified and offered preventive actions aimed at reducing their risk of falling.

[Mortality-associated factors in nonagenarian. The Nona-Santfeliu Study. Two years of follow-up]. / Factores asociados a mortalidad en nonagenarios. Estudio NonaSantfeliu. Seguimiento a los dos años.

OBJECTIVES: Few studies have prospectively evaluated predictors of mortality in the very elderly. This study has aimed to determine which factors could predict death in nonagenarians after two years of follow-up. PATIENTS AND METHOD: 176 nonagenarians were evaluated prospectively, 137 (74%) of whom lived in their own home and 49 (26%) of whom were institutionalized. Sociodemographic data were collected. Functional status was determined by the Lawton-Brody and the Barthel index, and cognition by the Spanish version of the Mental State Examination (MEC). The Charlson index was used to measure overall co-morbidity. RESULTS: The sample consisted of 135 women (76.3%) and 41 men. Mean age was 93 +/- 3.2 years. Mean Barthel index was 60.8 +/- 30, Lawton index 2.1 +/- 2.2 and MEC 21 +/- 11. The mean of Charlson index was 1.4 +/- 1.7. Six-four patients had died after two years of follow-up (36.3%). Charlson index (oR 1.370, 95% Ci 1.113-1.686, p < 0.003), Lawton index (OR 0.750, 95% CI 0.586-0.960, p < 0.02) and MEC (OR 0.964, 95% CI 0.932-0.997, p < 0.003) were variables independently associated with death after 24 months of follow-up. CONCLUSION: Higher comorbidity, incapacity to perform instrumental ADL at baseline and poor cognitive status are predictors of mortality after 2 years of follow-up in nonagenarians.

Characteristics of falls producing hip fractures in nonagenarians.

OBJECTIVES: To evaluate the characteristics associated with falls causing hip fracture in patients 90 years of age or older (nonagenarians). A second objective was to compare these characteristics with those present in younger patients (65-79 year-olds). DESIGN: Prospective, observational study. SETTING: Six hospitals in Barcelona (Spain) and its surrounding area. PARTICIPANTS: 105 nonagenarians diagnosed with hip fracture after a fall. Most patients were women (78; 74%), with a mean age of 92.2+/-2 years. All of them were living in the community, except for eight institutionalized patients. 221 patients aged 65 to 79 composed the younger patient's comparison group. MEASUREMENTS: Characteristics of falls causing hip fracture were analyzed: location, time and the risk factor for the fall, classified as intrinsic, extrinsic or combined. RESULTS: The mean number of falls in the previous year was 1.5 - 22% of the patients reported having fallen two or more times. Falls usually happened while at home (70%) and during the day (64%). An intrinsic risk factor was considered the most likely cause in 37% of the cases, an extrinsic risk factor in 35%, and a combination in 28%. Multiple stepwise logistic regression analysis showed that nonagenarians were characterized by lower BI scores, more falls happening during night time, a higher use of, benzodiazepines and diuretics, and a lower use of non-benzodiazepinic hypnotics. CONCLUSIONS: Most falls causing hip fracture in nonagenarians happen during the day and at home. Falls in nonagenarians happening more frequently during nighttime, and these oldest subjects had lower BI scores, and a higher use of benzodiazepines and diuretics and less use of non-benzodiazepines hypnotics compared with the younger patients.

Influence of the antioxidant content of saliva on dental caries in an at-risk community.

OBJECTIVE: This study aims to evaluate the relationship between the total antioxidant capacity of saliva and the presence of dental caries in deciduous and permanent teeth, in a group of Saharan children. METHODS: The dental examination was carried out in accordance with the recommendations of the World Health Organization (WHO). The total antioxidant capacity of the saliva was determined by colorimetry. RESULTS: The total antioxidant capacity (TAC) of the saliva of patients with caries in deciduous teeth was 2.89 1/IC50 greater than among those without. We observed a statistically significant linear regression between the number of deciduous teeth affected by caries and the total antioxidant capacity of the saliva: y = 0.24 + 0.53 x TAC saliva (t = 2.93; p = 0.004) (95% CI of b: 0.018-0.088). CONCLUSIONS: Our results show that the amount of caries in deciduous teeth is in direct proportion to the observed TAC of saliva, and that the presence of caries in deciduous teeth is associated with caries in permanent teeth.

[Circumstances associated to falls resulting in hip fracture in community-dwelling subjects older than 94 years old]. / Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes mayores de 94 años no institucionalizados.

OBJECTIVE: To evaluate the circumstances associated with falls resulting in hip fracture in the 95 years of age or older community-dwelling patients. MATERIAL AND METHODS: A prospective, observational study, was conducted in 6 hospitals in the Barcelona area on the characteristics associated with falls resulting in hip fracture in 30 patients aged > 94 years old. Location, time and the risk factor for the fall (classified as intrinsic, extrinsic or combined) were evaluated. RESULTS: Mean number of falls in the previous year was 1.6, 5 (16.7%) of the patients reporting having fallen two or more times. Falls usually occurred while at home, a high percentage (46.7%) of which occurred during the night. When the differences were evaluated by sex, there was a high percentage of uncorrected auditory loss in men and high number of chronic drugs and psychotropic drugs in women. CONCLUSIONS: Most falls causing hip fracture in community-dwelling very elderly subjects occur at home. Nearly half of the falls occur during the night.

[Characteristics of falls producing hip fracture in an elderly population. Differences according to age and gender]. / Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes ancianos. Diferencias por grupo de edad y género.

BACKGROUND: The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients. MATERIAL AND METHODS: Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined. RESULTS: We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination. CONCLUSIONS: The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures.

[Quality of medical diagnosis in sick leave certificates for non-occupational diseases and injuries]. / Calidad del diagnóstico médico en la certificación de la incapacidad temporal por enfermedad común y accidente no laboral.

OBJECTIVE: To evaluate the quality of medical diagnosis in the sick leave certificate. DESIGN: Retrospective, observational study. SETTING: Castelldefels Primary Care Centre, Barcelona, Spain. MEASUREMENTS AND INTERVENTIONS: 205 sick leave episodes of patients reported as non-occupational diseases and injuries were analyzed. The diagnosis of the sick leave certificate was checked against the clinical report carried out by the same physician who made out the sick leave certificate. To assess the quality of medical diagnosis, sensitivity, positive predictive value and the percentage of positive agreement were calculated. The variability of these indicators was also assessed according to the duration of the sick leave episode. RESULTS: Simple agreement between the diagnoses of the sick leave certificate and the clinical report was 92%. The sensitivity of the sick leave certificate in relation to the clinical report by diagnostic group ranged from 75% to 97%; positive predictive value, from 81% to 100%; and the percentage of positive agreement, from 86% to 97%. Short-term sick leave episodes (< or =15 days) had lower values than long-term sick leave (>15 days). CONCLUSIONS: Our findings confirm that the quality of diagnosis on the sick leave certificate is high. The availability of more medical information about the reasons for the sick leave episode does not modify the quality of the diagnosis substantially.

Reported occupational respiratory diseases in Catalonia.

OBJECTIVES: A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. METHODS: In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. RESULTS: Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. CONCLUSIONS: The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.

Occupation, tobacco use, coffee, and bladder cancer in the county of Mataro (Spain).

This report presents the results of an epidemiologic case-control study. The study includes 58 cases and 116 controls from both sexes, selected from the Admission Register of the Hospital and from the Death Registry Office of the local city authorities. Controls have been matched to cases by age, sex, place of residence and source of selection. The results demonstrated no increased risk associated with coffee consumption. Habitual smokers present a 2.3 times higher risk than nonsmokers. The estimated relative risk for occupation standardized by age and smoking habit, is 5.5. A multiplicative effect of the simultaneous action of smoking and occupational exposure has been observed to be an estimated relative risk of 11.7. The attributable risk of the population has been estimated to be 39% for smokers and 12% for occupational exposure. A strong association was found between bladder cancer and occupational exposure to carcinogenic substances, especially in the dye and print textile industries.

[Effect of insulin on cardiac contractility (author's transl)]. / Efecto de la insulina sobre la contractilidad cardíaca.

The effects of insulin on contractile activity of isolated heart muscle have been studied in the rat's right ventricle. The method of the isolated organ bath was used with Tyrode as perfusion liquid with constant carbogen bubbling. The addition of insulin to the bath (0.3 U/ml) increased the contractile power. Contractility increase, induced by adrenaline and CaCl2, was reduced by insulin. This decrease of adrenaline activity became clearer after partial blocking of beta-receptors with pindolol. Glucose determinations in the bath also showed an insulin-adrenaline antagonism. Insulin behaved as a partial agonist versus adrenaline at the beta-receptors site.

Effects of adrenergic blockers on platelet aggregation.

The action of orciprenaline, tolazoline, propanolol and inpea on platelet aggregation induced by ADP epinephrine and norepinephrine was studied in vitro in human platelet-rich plasma. Orciprenaline did not significantly affect aggregation induced by ADP. Tolazoline inhibits the aggregation induced by epinephrine and norepinephrine more intensely than the beta-blockers. Inpea blocks the platelet aggregation induced by epinephrine and norepinephrine to a greater extent than propanolol at similar concentrations. The beta-blockers inhibit platelet aggregation non-specifically.

Effects of carbenicillin and phosphomycin on ADP induced platelet aggregation.

The effects of carbenicillin and phosphomycin separately or simultaneously, on ADP induced platelet aggregation have been studied in vivo. Platelet aggregation, ADP induced, was inhibited by carbenicillin and phosphomycin. The inhibition was proportional to the concentration of antibiotic. A slight inhibition was observed when platelet rich plasma was incubated simultaneously with both antibiotics, but synergy on the ADP-induced platelet aggregation was absent.