Treatment of osteoporosis and hip fractures in a Spanish health area.

OBJECTIVE: The aim of this longitudinal retrospective ecological study was to evaluate the consumption of anti-osteoporotic medications and the evolution of pertrochanteric and femoral neck (FN), subtrochanteric and diaphyseal hip fractures between 2005 and 2010. MATERIALS AND METHODS: Data were obtained from our Hospital Admissions Service (absolute number of fractures) and the Technical Directorate of Pharmacy (defined daily dose and absolute number of containers consumed of bisphosphonates (BP), raloxifene and strontium ranelate). RESULTS: The overall incidence density of FN in 2005-2010 was 124.8 new cases per 100,000 persons per year. BP consumption increased between 2005 and 2010 to a peak of 70,452 containers consumed in 2010, while consumption of raloxifene declined. The number of subtrochanteric and diaphyseal fractures remained stable, but FN reached a peak in 2008 (N = 350) and fell thereafter (N = 284 in 2010). The percentage reduction in the number of FN in the period studied (2009: -14% and 2010: -11% compared to 2005) corresponds temporally with the increased consumption of BP (2009: +76% and 2010: +84% compared to 2005). CONCLUSIONS: We found an inverse temporal association between the annual consumption of BP and the annual number of FN during 2005-2010. This is probably related to the cumulative effect of BP, although, given the limitations of the study design, other studies are needed to confirm our data.

Effectiveness of Twitter Threads to Improve Medical Student Electrocardiogram (ECG) Reading-Skills. The TwittUVa-ECG Non-Randomized Pre-Post Study.

Introduction: social media is increasingly used in medical education, but its real educational effectiveness is unclear. In this study we assess the effectiveness of Twitter threads (TTS) in improving electrocardiogram (ECG) basic reading skills (ECGBRS). Materials and Methods: Seven TTS describing ECGBRS were published from October 28, 2021, to November 24, 2021. Tests were used to assess medical students ECGBRS pre and post intervention. All third and sixth-year medical students were invited to participate. Sixty-three students were enrolled (33 third year and 30 sixth year). Nine (14.3%) participants dropped out. Results: Sixth year medical students had higher ECGBRS at baseline. The number of correct items increased after the Twitter intervention; median correct pre-test items were 20 out of 56, (interquartile range (IQR) 14-23), and median post-test were 29 out of 56, (IQR 21-36) (p < 0.001). The improvement in sixth year students was greater than for third year students; 10 more correct items (IQR 4-14) vs. 7 (IQR 1-14) items (p = 0.045). The more TTS followed, the greater the improvement in ECGBRS (p = 0.004). The QRS axis calculation was the ECG reading skill with the lowest scores. Most medical students were definitely (35%) or very probably (46%) interested in repeating another on-line learning experience and found the TTS extremely (39%) or very (46%) interesting. Conclusions: The use of specifically designed TTS was associated with improvement in medical students' interpretation of ECGs. The effectiveness of the threads was higher in the final years of medical school when basic skills had already been acquired. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01885-x.

Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.

AIM: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. METHODS: Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. RESULTS: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004). CONCLUSIONS: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.

Vinegar decreases allergenic response in lentil and egg food allergy.

BACKGROUND: Food allergy results from an atypical response of the mucosal immune system to orally consumed allergens. Antacid medication inhibits the digestion of dietary proteins and causes food allergy. A decrease of the gastric pH might enhance the function of digestion and reduce the risk of food allergy. OBJECTIVE: To test a possible decrease in the allergenicity of powerful food allergens (egg, chicken, lentils) with the addition of vinegar during the cooking process. METHODS: We included seven patients who suffered from anaphylaxis due to egg, chicken and lentils. We added vinegar to egg, chicken and lentil processed extracts used for skin prick tests (SPT) and compared the wheal areas obtained with the same extracts sources and the same way but without vinegar addition. Immunodetection was performed with the different processed extracts and patients' sera. Only one patient consented food challenge with vinegar-marinated-chicken. RESULTS: Wheal areas were significantly minor with the food extract with vinegar. Immunodetection showed a decrease of the response with vinegar processed extracts. CONCLUSIONS: Vinegar addition during the cooking process may decrease lentil and chicken allergenicity.

Clinical significance of cross-reactivity between tobacco and latex.

BACKGROUND: Allergen cross-reactivity between tobacco and other species of Solanaceae family (tomato, potato, aubergine and egg plant) have been reported. We have recently studied IgE response to tobacco in asthmatic patients sensitised to Lolium perenne (Perennial rye grass pollen) and have found that 30% of the tobacco responsive patients also have latex sensitisation. OBJECTIVE: The aim of our study was to investigate the possibility of cross-reactivity between tobacco and latex in asthmatic patients with IgE response to latex. METHODS: A study was performed on tobacco and latex exposure in 15 patients who suffered from asthma and latex sensitisation and who were randomly chosen from our database of latex-sensitive patients. To identify tobacco and latex as possible allergens that might cause clinical specific responses, all these patients were tested with prick-tests, specific IgE to tobacco, latex and related allergens, bronchial challenge, and patch tests with tobacco, latex and nicotine. Immunological response was evaluated with immunoblotting, immunoblotting-inhibition and EAST-inhibition tests. RESULTS: Positive prick and bronchial challenge with specific IgE>0.35 kU/L to tobacco was demonstrated in 11 asthmatics who were also sensitised to rye grass. Tobacco IgE level was related with sensitisation to latex (p<0.002), but not to other vegetables belonging to the Solanaceae family. EAST-inhibition and immunoblotting-inhibition showed the existence of cross-reactivity between tobacco and latex. CONCLUSIONS: Cross-reactivity exists between latex and tobacco allergens. Smoker patients with IgE response to tobacco may be a risk population for latex sensitisation.

Are beta-blockers useful in the prevention of osteoporotic fractures?

Atherosclerosis and osteoporosis are highly prevalent chronic diseases that affect populations of similar ages who are clinically asymptomatic until complications appear. Therefore, research into new drugs that are useful for both processes and may improve therapeutic compliance appears to be reasonable. beta-blockers are widely used in the treatment of hypertension and its complications, ischemic heart disease and heart failure. Their use has been associated with a decrease in cardiovascular mortality. Experimental data have demonstrated that the sympathetic nervous system inhibits bone formation and increases resorption due to the binding of catecholamines to receptors located in osteoblasts. This produces a decrease in bone mineral density and a higher risk of fractures. The effect is eliminated by the administration of beta-blockers. Retrospective case-control and cohort studies have shown a beneficial effect of beta-blockers on fractures reduction, with a protective effect being observed in eight studies and no effect being found in two studies. The aim of this paper is review these data and the possible role of beta-blockers in the prevention of osteoporotic fractures in patients with cardiovascular disease.

Atherosclerosis and osteoporosis.

Atherosclerosis and osteoporosis are degenerative chronic diseases with a high incidence in developed countries. They are silent processes with a great economic cost that becomes evident when complications become overt. Numerous epidemiological studies show an independent association between the two diseases that is not related to age or other cardiovascular risk factors. This review analyzes the clinical studies that support this association and describes the possible common etiopathogenic and physiopathological mechanisms.

Patrón de intoxicaciones pediátricas en Urgencias. Evolución tras 20 años / Pattern of pediatric poisoning in the ER. Evolution after 20 years

Objetivo. Describir y comparar los datos de las intoxicaciones pediátricas, por fármacos y no medicamentosas, enla urgencia pediátrica en 2 cohortes de 2 décadas distintas.Material y métodos. En este estudio descriptivo retrospectivo, de 2 cohortes de pacientes que acudieron a Urgencias en el año 1997 y en el año 2015. Se compararon lascaracterísticas epidemiológicas, clínicas, la adecuación deltratamiento a las guías de los pacientes menores de 14 añosque acudieron a las Urgencias Pediátricas de nuestro hospital.Resultados. En nuestra serie ha habido un aumento delas intoxicaciones por medicamentos, de un 40% en 1997 a un53% en 2015. Por el contrario, se ha encontrado un descensorelativo de las consultas por tóxicos no medicamentosos 60%vs 47%. La distribución por sexo, con predominio femeninoen las intoxicaciones farmacológicas, y masculino en las nofarmacológicas. Las características clínicas no han variado,predominando al clínica digestiva y neurológica. Los tóxicosimplicados han variado con relación a las indicaciones encada período de tiempo, desapareciendo las intoxicacionespor aspirina en la última década. El tratamiento en Urgenciasse ha adecuado a los estándares de calidad que publican lassociedades científicas, abandonando tratamientos que se handemostrado de baja eficacia, como el jarabe de ipecacuanay los lavados gástricos. Los ingresos en nuestra serie handisminuido de un 25% vs 3%, contribuyendo entre otrascausas el desarrollo y especialización de las Unidades deUrgencias Pediátricas.Conclusiones. A pesar de que ciertos datos indican unamejora de la asistencia, sigue habiendo muchos puntos demejora para que la morbimortalidad de las intoxicaciones en pediatría disminuya (AU)

Objective. To describe and compare data on pediatricpoisonings, drug and non-drug, in the pediatric emergencydepartment in 2 cohorts from 2 different decades.Material and methods. This is a retrospective descriptive study of 2 cohorts of patients attending the emergencydepartment in 1997 and 2015. We compared the epidemiological and clinical characteristics and the adequacy of treatmentaccording to the guidelines of patients under 14 years of age,who were attended at the pediatric emergency departmentof our hospital.Results. In our series there has been an increase in drugpoisonings, from 40% in 1997 to 53% in 2015. In contrast,there was a relative decrease in consultations for non-drugintoxications, 60% vs 47%. The distribution by sex, with afemale predominance in pharmacological poisonings, and amale predominance in non-pharmacological poisonings. The clinical characteristics did not vary, with a predominance ofdigestive and neurological symptoms. The toxins involvedhave varied in relation to the indications in each period oftime, the aspirin poisonings disappearing in the last decade.Treatment in the emergency Department has been adaptedto the quality standards published by scientific societies,treatments that have been shown to be of low efficacy hasbeen abandoned, such as syrup of ipecac and gastric lavage.Admissions in our series have decreased by 25% vs 3%,contributed among other causes by the development andspecialisation of paediatric emergency units.Conclusions. Despite certain data indicating an improvement in care, there are still many points of improvementfor the morbidity and mortality of poisoning in pediatrics to decrease. (AU)

In-hospital mortality due to infectious disease in an Internal Medicine Department. Epidemiology and risk factors.

OBJECTIVE: Hospital mortality is a leading indicator of quality of healthcare and a valuable tool for planning and management. Infectious diseases represent a substantial part of the activity of internal medicine.Our aim was to describe the characteristics of in-hospital mortality due to infectious diseases and associated risk factors in our environment. MATERIALS AND METHODS: A retrospective case-control study was designed. We reviewed deaths during 2012 from an Internal Medicine Department. 187 cases (infectious disease related mortality) and 224 controls were found. Clinical and demographic information was obtained from medical records. Comorbidity was evaluated with Charlson index (CI). Data were analyzed using SPSS 15.0 (p-value < 0.05). RESULTS: During 2012, of the 3193 discharge, 187 were exitus due to infectious disease (5.8%). Mean age was 85.7 ± 7.6, higher in women (88 ± 7 vs 83 ± 7.4, p < 0.001), and 55% were aged over 85 years. The CI mean was 4.2 ± 3, higher in younger than 85 years (5.3 ± 3.4 vs 3.6 ± 2.6, p < 0.001). Most frequent causes of death were respiratory sepsis (29%), severe pneumonia (23.5%) and urinary sepsis (16.6%) and risk factors were living in Nursing Home (55.6% vs 34%, p < 0.001), being dependent (73.8% vs. 44.6%, p < 0.001), dementia (59.4% vs 27.2%, p < 0.001) and cerebrovascular disease (25.7% vs 17.4%, p = 0.041). CONCLUSIONS: Dementia, cerebrovascular disease, living in Nursing Home and being dependent were risk factors for infectious disease in-hospital mortality in our study, but not comorbidity, age or length of stay. Our series, although limited by retrospective design, is the first qualitative study of in-hospital mortality due to infectious disease in an Internal Medicine Service in our environment. Most frequent cause of death in our setting was respiratory etiology.

Predictores del riesgo de fractura en una población de mujeres postmenopáusicas mediante el procedimiento estadístico binario CART / Fracture risk predictors of a postmenopausal female population by binary statistical procedure

Objetivo: La principal consecuencia de la osteoporosis es la fractura por fragilidad asociada a elevada morbimortalidad. La predicción de la misma puede ayudar a identificar la población de mayor riesgo y establecer medidas de prevención. El objetivo de este estudio fue valorar la utilidad de diversos factores en su prevención comparando la densidad mineral ósea (DMO), el cálculo del riesgo absoluto de fractura con la herramienta FRAX® con y sin DMO, y los datos clínicos. Material y métodos: Se realizó un estudio longitudinal de 8 años de duración en una población de mujeres postmenopáusicas, osteoporóticas y no osteoporóticas. A todas ellas se les realizó una historia clínica protocolizada, DMO de columna y cadera, y el FRAX con y sin DMO. A los 8 años se identificaron las fracturas existentes. Además de realizar una estadística paramétrica y no paramétrica con SPSS 21.1, se realizó un método del árbol de clasificación y regresión (CART) para evaluar las posibles interacciones entre los factores de riesgo de fractura. Resultados: Se incluyeron 276 pacientes postmenopáusicas cuya edad media al inicio del estudio fue de 61,08±8,43 años y un índice de masa corporal (IMC) de 25,67±4,04. El 56,5% de las pacientes (n=156) fueron diagnosticadas de osteoporosis antes del inicio de nuestro estudio, y todas ellas fueron tratadas. Pasados los 8 años de seguimiento, 72 pacientes (24,6%) sufrieron fractura y 17 (6,2%) también sufrieron una segunda fractura. Los resultados del análisis CART nos mostraron que el principal factor de riesgo para sufrir una fractura osteoporótica tras 8 años de seguimiento fue el haber sufrido fracturas previas. Entre las pacientes que habían sufrido una fractura previa, el tener una DMO del cuello femoral menor de 0,67 fue el principal factor de riesgo. (AU)

Objetivo: The main consequences of osteoporosis are fragility fractures, associated with high morbimortality. The prediction of these fractures can help identify the most-at-risk population and implement preventive measures. The aim of this study was to assess the usefulness of multiple factors in their prevention, comparing the bone mineral density (BMD), the calculation of absolute risk of fracture using the tool FRAX® in the presence and absence of BMD, and the clinical data. Material and methods: An eight-year-duration longitudinal study was conducted on a postmenopausal female population, with and without osteoporosis. All of them were taken a standardised clinical history, spinal and hip BMD, and FRAX with and without BMD. Eight years later we identified the existent fractures. In addition to a parametric and non-parametric statistic in SPSS 21.1, we used the classification and regression tree (CART) method to assess possible interactions among fracture risk factors. Results: We studied 276 postmenopausal patients whose average age at the beginning of the study was 61.08±8.43 years-old and had a body mass index (BMI) of 25.67±4.04. 56.5% of the patients (n=156) were diagnosed with osteoporosis before the beginning of our study, and all of them were treated. After eight years of follow-up, 72 patients (24.6%) suffered a fracture and 17 patients (6.2%) also suffered a second one. The results of the CART analysis showed that the main risk factor to suffer an osteoporotic fracture after 8 years of following up is having preceding fractures. Having a femoral neck BMD lower than 0.67 was the main risk factor among those with a previous fracture. Conclusions: The use of a binary statistical procedure (CART) on a cohort of patients allow us identify those most at risk of fractures, according to clinical parameters and simple additional tests, in order to establish more effective therapeutic measures. (AU)

Effects of chronic treatment with amiodarone on hepatic demethylation and cytochrome P450.

The effect of chronic treatment with amiodarone on hepatic oxidative metabolism using an in-vivo [14C]aminopyrine breath test and on hepatic cytochrome P450 was examined in Wistar rats. Aminopyrine demethylation was significantly impaired but returned to pretreatment values following amiodarone for 4 weeks. In contrast the levels of cytochrome P450 were significantly depressed during treatment and at 4 weeks following treatment. While an inhibitory effect on oxidative metabolism may explain the reported drug interactions with amiodarone, the discrepancy between its in-vivo effects and cytochrome P450 levels may suggest the development of 'compensatory' extra-hepatic site of drug metabolism.

Side-effects of sodium valproate, mainly related to its hepatic and pancreatic toxicity.

A study was made of 134 patients (67 males and 67 females) treated with sodium valproate, with ages from 1.5 to 70 years (50 on monotherapy and 84 on multitherapy), to detect side-effects of this treatment. To meet this goal, a clinical questionnaire was used with special emphasis on biological parameters to detect hepatic and pancreatic toxicity. 71.6% developed side-effects, without differences either between groups of sex or age, or patients on monotherapy and multitherapy, or the duration of the treatment, longer or shorter than six months. The side-effects were mild and transient, and without relationship with doses or plasma levels of the drug. The most noticeable side-effects in the study were the increase in amylase values, mainly in urine (23.9%), eosinophilia (30% in the monotherapy group), increase in gamma-glutamyltranspeptidase (20.2% in the polytherapy group) and weight gain in 25% of adult women on polytherapy. Only a 4.7% developed mild and transient elevation of transaminases, that did not differ from the control population. The relevance of using a clinical questionnaire and biological parameters to evaluate the side-effects of a drug is emphasized.

Effects of dimethylsulfoxide on the oxidative metabolism of certain tissues in rats in vitro.

Administration of 10 mM dimethylsulfoxide inhibits oxygen uptake in in vitro rat brain slices incubated in a Krebs-Ringer phosphate pH 7.4 solution containing 10 mM glucose. The effect is inverted when excessive potassium is added to the solution and the amount of sodium chloride is substituted by choline chloride. Using 10 mM, we observed a decrease in oxygen uptake in rat heart slices incubated in a Krebs-Ringer phosphate solution containing 131.8 mM Na+, 105.4 mM K+ and no calcium. Dimethylsulfoxide 10 mM, 1 mM and 0.1 mM does not alter the Na+/K+ ATPase activity nor the ouabain insensitive ATPase activity in in vitro preparations of rat brain, kidney and heart.

[Smoking in the general population: a description of prevalence, degree of consolidation and phase of cessation]. / Hábito tabáquico en una población general: descripción de la prevalencia, grado de consolidación y fase de abandono.

Smoking is a risk factor associated with high and preventable mortality and morbidity. An understanding of smoking consolidation and the desire to quit in specific subgroups of the general population will facilitate appropriate planning of health care resource utilization. We performed a multistage, random, stratified cross-sectional study in the general population of Valladolid (Spain) during 1998 and 1999 as part of a cardiovascular disease risk survey. Data collected by questionnaire and interview included number of cigarettes smoked per day, nicotine dependence and stage in the process of smoking cessation. Venous carboxyhemoglobin was also measured. The percentage of reported smokers in the general population was 29.3% (95% CI: 25.7-32.9%). Prevalence was 41.8% (95% CI: 39.2-44.5%) in the 26-to-45-year-old age group and fell to 6% (95% CI: 5.6-6.5%) among subjects over 66 years of age. Analysis by sex, 31.2% (95% CI: 26.1-36.4%) of men and 27.4% (95% CI: 24.1-30.7%) of women were smokers. In rural areas the percentage of smokers was 26.9% (95% CI: 20.2-33.5%) whereas the percentage in urban areas was 31.2% (95% CI: 26.1-36.4%). The number of cigarettes/day, venous carboxyhemoglobin and nicotine dependence differed by age range, sex and place of residence and helped to describe the degree of consolidation of smoking by strata. Phases of cessation were distributed similarly by age range but not by sex. The prevalence of smoking is still high, particularly among young people and women, although it is tending to decrease. Smoking is better established in the 26-45 year-old age range, among men, among those living in rural areas and among older smokers who, probably, can not quit smoking alone.

[Adverse reactions to antihypertensive drugs]. / Reacciones adversas a fármacos antihipertensivos.

OBJECTIVE: In chronic therapies, the less number of adverse effects (AE) to drugs is decisive to improve the rate of performance and reach the protective objective. We can make comparisons in the rate of tolerance of antihypertensive drugs (AD) if we study all of them with the same method in patients with real hypertension. METHODS: Analyzed 922 hospitalized hypertensive patients looking for adverse effects (AE) reported systematically and spontaneously form, the causality must to excel in two algorithms the uncertain grade. RESULTS: 13.47% of antihypertensive drugs presented an AE, beta-blockers presented more AE than diuretics and angiotensin-converting enzyme (ACE) inhibitors. CONCLUSIONS: The AD haven't the same AE neither feature nor frequency. If to dependent on a poor fulfillment, we lose the protective effectiveness, the application independently of the economic cost isn't right.

[Telmisartan effect's on remodelling bone markers in hypertensive patients]. / Efecto de telmisartan sobre marcadores del remodelado óseo en pacientes hipertensos.

INTRODUCTION: The telmisartan is an angiotensin II receptor blocker (ARB) with a few own characteristics that it allows us to obtain a few additional benefits. It displays the ability to act as a partial agonist of PPARgamma. On the other hand, PPAR gamma intervenes in the control of bone remodelling though with not concordant results. The objective of this study to value the effect of telmisartan on bone markers in hypertensive patients. SUBJECTS: A sample of 31 hypertensive patients with hypertension were included. The dose of telmisartan was of 80 mg/24 h and the period of follow-up was 12 weeks. The control group included 32 hypertensive patients treated before with IECA (enalapril-20 mg/24 h - or quinapril - 40 mg/24 hours). The following parameters were determined P1NP, ß-CTX, 25OHD and PTH , osteocalcin, insulin and adiponectin. RESULTS: The patients treated with Telmisartan shown a significantly decrease in systolic blood pressure (156 ± 19 mmHg vs 133 ± 15 mmHg, p = 0.001) and diastolic blood pressure (92 ± 9 mmHg vs 82 ± 6 mmHg, p = 0.01) . Changes were not observed in other parameter, PTHi (48 ± 22 pg/ml vs 45 ± 22 pg/ml, p > 0.05) and 25-vitamin D (21 ± 10 ng/ml vs 25 ± 8 ng/ml, p > 0.05), CTX (0.195 ± 0.12 ng/ml vs 0.221 ± 0.13 ng/ml, p > 0.05), PINP (39 ± 20 ng/ml vs 40 ± 19 ng/ml, p > 0.05), osteocalcin (11 ± 9 ng/ml vs 11 ± 5 ng/ml, p > 0.05), glucose, adiponectin, insulin and HOMA. When the patients divided in two groups depending on the levels of vitamin D (insufficient and not insufficient), with a cut of 20 ng/ml, there was changes on bone markers but a decrease of the glucose was observed in patients with levels of vitamin D over 20 ng/ml (135 ± 53 mg/dl vs 119 ± 39 mg/dl, p = 0.01). The patients treated with IECAS decreases the systolic blood pressure but the diastolic blood pressure values of arterial systolic does not show changes. CONCLUSIONS: Telmisartan has a neutral effect to level of the bone markers of bone remodelling.

[Dietary intakes in a group of marihuana smoking patients]. / Ingesta dietética en un grupo de pacientes fumadores de marihuana.

BACKGROUND: Marihuana use has effects on appetite; studies in the literature on this topic area are limited. The aim of our work was to evaluate the dietary intake of marihuana smoking patients. PATIENTS AND METHODS: A total of 32 male subjects were enrolled (average age 37.25 +/- 8.8 years). In all patients were determined weight, height and body mass index and a three days nutritional questionnaire. RESULTS: Total calories intakes were higher (3,350.1 +/- 979 kcal/day). Distribution of calories was 44.3% of carbohydrates, 14% of proteins and 41.7% of lipids (50.6% mono-unsaturate fats, 36.3% saturate fats and 13.1% poluunsaturated fats). Total protein intake was 109.6 +/- 38.5 g/day and corrected by weight was 1.62 +/- 0.73 g/kg. Low intake of vitamin D, E, folic, magnesium and iodine were detected. High intake of vitamin A, C, K, thiamine, riboflavine, B6, niacin, B12, calcium, iron and zinc were observed. No statistical differences in dietary intake or weight were detected between groups of marihuana users by median of consumption time of this drug. CONCLUSIONS: Marihuana smoking patients realized a hipercloric and hiperproteic diet, with high amounts of fats and with an intake of micronutrients above international recommendations. This dietary intake has not related with weight.

[Basis for the clinical management of fire smoke poisoning "Docohumo Madrid 2010"]. / Bases del manejo clínico de la intoxicación por humo de incendios «Docohumo Madrid 2010¼

Poisoning by smoke is the main cause of morbidity and mortality in fires. Smoke is a mixture of carbonaceous particles suspended in hot air and toxic gases. Of these, carbon monoxide (CO) and primarily hydrocyanic acid (CNH), are those that provoke tissue anoxia. The clinical manifestations of smoke poisoning are variables. Some of the potential manifestations could be: eye irritation, sore throat, laryngeal stridor, dysphagia, carbonaceous sputum, cough, dyspnea, laryngospasm, bronchospasm, coronary syndrome, coma, hypoxemia, lactic acidosis, cyanosis and death. In the assessment of these patients the presence of soot in the nose, mouth or sputum suggests serious poisoning. Lactate levels higher than 10mmol/L indicates levels of cyanide major than 40micromole/L. The pulse co-oximetry has assumed an important step forward for the diagnosis, appraisal and monitoring of these patients. In the treatment it will be essential to assess the need of an early intubation. The administration of oxygen to the 100% will be essential. As an antidote to the cyanide, the first-choice is the hydroxocobalamin. Its administration has to be early. Its administration criteria are: patient who has inhaled smoke (remnants of soot in the mouth, pharynx or sputum) and has neurological disorder (confusion, coma, agitation, seizures) and also presents one of the following circumstances: bradypnea, respiratory arrest, cardiorespiratory arrest, shock, hypotension, lactate ≥8mmol/L or lactic acidosis. Logically, the rest of the management will be conventional depending on symptoms or complications.