Respuesta del autor: Prescripciones ineficaces e inapropiadas en ancianos. ¿Sirven los criterios de Beers? / Autor’s reply: Ineffective and inappropriate prescriptions in the elderly. Are the Beers criteria useful?

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Prescripciones ineficaces e inapropiadas en ancianos. ¿Sirven los criterios de Beers? / Potentially inappropriate and inefficient prescriptions for older patients in long term - care. Is beers’s criteria useful?

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Effect of age on cytokine response in an experimental model of osteomyelitis.

To study the effect of age on cytokine response in an experimental model of osteomyelitis. Forty adult male Wistar rats received a stainless steel needle, intramedullarly in the left tibia. Young rats (3 months old) and old rats (22 months old) were allotted in: Group A: Sterile implant. Group B: Sterile implant + slime producing S. aureus. Rats were sacrificed 9 weeks after surgery. Determinations: Cytokines (ELISA) in blood and in tibia extract and the number of bacteria in tibia and implant. The Wilcoxon, Mann-Whitney U tests were used (P < or = 0.01 significant). Infection was detected in every old rat receiving S. aureus, and in 7 of 10 young rats. In blood: prior to surgery, old rats presented higher IL-2 and lower IL-4 levels. Surgery alone did not induce significant changes in old rats; surgery + S. aureus induced significant increases of IL-2 and IL-10 in young rats, and of IL-6 in old rats. Tibia analysis S. aureus group showed increased levels of: IL-10 in young rats, and IL-1beta in old rats. In experimentally induced osteomyelitis, significant differences were observed in cytokine response with regard to age.

Immune cell variations in patients with hip fracture.

Hip fracture is an increasing pathology in the patients with increasing age. Immunological response differences may appear between different age groups. The purpose of this study was to investigate the immune response in patients with subcapital hip fracture and the relationship with age. Prospective study of 100 patients with displaced subcapital femoral fracture between 2000 and 2004, divided into three age groups: over 90 years (13), 80-90 (56) and under 80 years (27). The chi(2)-test, analysis of variance and Student's t-test were applied. Correlation coefficient and the Spearman test were used to study linear correlation. The T helper cells decreased with age, this inverse correlation was significant. There was a direct correlation between CD16% and age. IgA, IgG and IgM levels did not show any significant relationship with age in our study. Nevertheless, the IgE levels in peripheral blood showed a significant direct correlation with age. Basophils percentage presented an inverse correlation with age. Age is associated to some immune changes in patients suffering hip fracture.

Interleukin-1, interleukin-6, and interleukin-10 responses after antibiotic treatment in experimental chronic Staphylococcus aureus osteomyelitis.

BACKGROUND: Staphylococcal implant infections' response to treatment may be correlated with cytokine production. We investigated the effect of certain antibiotics on the cytokine response in experimental osteomyelitis. METHODS: A stainless steel needle with an adherent slime-producing Staphylococcus aureus was implanted intramedullarly in the left tibia of 40 adult male Wistar rats. At 42 days after implantation, cefuroxime, vancomycin, tobramycin, and ciprofloxacin were administered intramuscularly every 12 h for 21 days. The control group was given no antibiotic. At the end of the treatment, implants and tibias were retrieved, and the bacterial numbers were estimated. Cytokines [interleukin-1alpha (IL-1alpha), IL-6, and IL-10] were determined (ELISA) in the tibial extract. RESULTS: Vancomycin and cefuroxime inhibited bone colonization in all tibias, and tobramycin and ciprofloxacin inhibited it only partially. Cefuroxime reduced the number of bacteria that adhered to the implants more than the other antibiotics. IL-1alpha and IL-6 showed higher levels in the ciprofloxacin-treated group than in the cefuroxime-treated and control groups. IL-6 levels in rats treated with cefuroxime were lower than in rats treated with tobramycin or vancomycin and the control group. Cefuroxime decreased IL-10 levels more than ciprofloxacin or vancomycin or those seen in the control group. CONCLUSIONS: The cefuroxime group showed the greatest decrease of pro-inflammatory cytokines. Different antibiotics produce different cytokine reactions that should be studied to choose the best treatment.

[Differences in clinical presentation between subjects with a phenotype of familial hypercholesterolemia determined by defects in the LDL-receptor and defects in Apo B-100]. / Diferencias en la presentación clínica en sujetos con fenotipo de hipercolesterolemia familiar por defectos en el receptor LDL y por defectos de la apo B-100.

INTRODUCTION AND OBJECTIVES: Familial hypercholesterolemia and familial defective Apo B-100 are phenotypically indistinguishable. At present they can be distinguished by genetic analysis. PATIENTS AND METHODç We compared the clinical features of 13 subjects with familial defective Apo B-100 and 39 subjects with familial hypercholesterolemia. We used data from first degree relatives to compare morbidity and mortality between the two groups. RESULTS: We found statistically significant differences in total cholesterol and LDL cholesterol, which were lower in the familial defective Apo B-100 group (TC = 357 37.3 mg/dl vs 415 79.7 mg/dl and LDLc = 270 34.2 mg/dl vs 355 72.4 mg/dl). We found no differences in xanthomas, corneal arcus, smoking status, vascular events, blood pressure, BMI or waist/hip ratio. There were no differences between the two groups in the proportions of patients with cardiovascular disease or patients who died. We found statistically significant differences between the groups (p = 0.023) in the mean age at first vascular event (familial hypercholesterolemia and first degree relatives: 45.3 19.9 years; familial defective Apo B-100 and first degree relatives: 51.5 20.8 years). CONCLUSIONS: We conclude that familial defective Apo B-100 results in clinically milder hypercholesterolemia than familial hypercholesterolemia, and that discerning between them could be helpful to stratify the risk in persons with hereditary hypercholesterolemia.

Diferencias en la presentación clínica en sujetos con fenotipo de hipercolesterolemia familiar por defectos en el receptor LDL y por defectos de la apo B-100 / Differences in clinical presentation between subjects with a phenotype of familial hypercholesterolemia determined by defects in the LDL-Receptor and defects in apo B-100

Introducción y objetivos. La hipercolesterolemia familiar y la apo B-100 defectuosa familiar resultan fenotípicamente indistinguibles. Hoy día es posible diferenciarlas mediante la realización de un análisis genético. Pacientes y método. Comparamos las características clínicas de 13 sujetos con apo B-100 defectuosa familiar y 39 sujetos con hipercolesterolemia familiar. Para comparar la morbimortalidad de ambos grupos utilizamos datos de sus familiares de primer grado. Resultados. Observamos diferencias significativas en los valores de colesterol total (CT) y colesterol unido a lipoproteínas de baja densidad (cLDL) de los sujetos afectados, que fueron menores en el grupo de apo B 100 defectuosa familiar (CT 357 ñ 37,3 frente a 415 ñ 79,7 mg/dl; y cLDL 270 ñ 34,2 frente a 355 ñ 72,4 mg/dl). No observamos diferencias en cuanto a la presencia de xantomas, arco corneal, hábito tabáquico, episodio vascular, presión arterial, índice de masa corporal (IMC) e índice cintura/cadera.No hubo diferencias significativas en cuanto a las proporciones de fallecidos y afectados de enfermedad cardiovascular de uno y otro grupo.La diferencia de medias de edad alcanzada sin enfermedad cardiovascular (45,3 ñ 19,9 años en la hipercolesterolemia familiar y familiares, y 51,5 ñ 20,8 años en la apo B100 defectuosa familiar y familiares) resultó significativa (p = 0,023).Conclusiones. La apo B-100 defectuosa familiar produce una hipercolesterolemia clínicamente más benigna que la hipercolesterolemia familiar, por lo que su diferenciación puede ayudar a estratificar el riesgo en los sujetos con estas hipercolesterolemias hereditarias (AU)

Musculoskeletal hydatid disease: a report of 13 cases.

This is a retrospective study of 13 patients with muscular hydatidosis--i.e., 4% of the 309 cases of hydatid disease treated in our department during 1983-1999. The commonest clinical finding was an asymptomatic and slowly growing mass (7). Puncture or incision of the mass was followed by an infection of the cystic cavity with fistulization in 2 patients. The immunological findings were false negative in 4 patients. MR images were obtained in 4 patients before diagnosis, and were highly suggetive of hydatid disease. The cystic cavities in all 9 patients subjected to radical surgery healed without chemotherapy. Radical surgery was not possible in 4 cases, in 3 of whom the sacrum was involved. Medical treatment of these patients did not eliminate the disease and new operations were necessary.