Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients.

The relation between age and mortality after hip fracture was analyzed in elderly patients. 5.5% of the 31,884 patients died. Compared to those 65-74 years old, the multivariate OR for mortality for those 75-84 and ≥85 were 2.11 (95% CI: 1.61-2.77) and 4.10 (95% CI: 3.14-5.35). PURPOSE: To analyze the impact of Elixhauser comorbidities on the relation between age and mortality after hip fracture in elderly patients. METHODS: Cross-sectional study of the population ≥65 years old hospitalized in Spain in 2013 with a diagnosis of fall-related hip fracture in the Basic Minimum Set Data (BMSD). The impact of Elixhauser comorbidities on the association between mortality and age groups (65-74, 75-84, ≥85) was analyzed by logistic regression models with progressive adjustment for demographic variables and comorbidities introduced individually. RESULTS: We identified 31,884 patients, 5.5% of which died during hospitalization. Compared with those 65-74 years old, the multivariate OR of mortality for those 75-84 and ≥85 years old decreased from 2.23 (95% CI: 1.71-2.90) and 4.57 (95% CI: 3.54-5.90) to 2.11 (95% CI: 1.61-2.77) and 4.10 (95% CI: 3.14-5.35), respectively after adjustment for comorbidities. The OR of mortality for men was 1.77 (95% CI: 1.58-1.98) compared to women. The comorbidities with higher OR for mortality were congestive heart failure (OR: 3.88; 95% CI: 3.42-4.41), metastasis (OR: 3.44; 95% CI: 2.27-5.20), fluid and electrolyte disorders (OR: 2.95; 95% CI: 2.47-3.52), coagulation deficiencies (OR: 2.87; 95% CI: 2.08-3.96), and liver disease (OR: 2.40; 95% CI: 1.82-3.17). CONCLUSIONS: The association between age and mortality after hip fracture remains after adjusting for numerous comorbidities. However, some potentially controllable disorders are associated with an increased risk for mortality, thus, improving their management could benefit survival.

Genetic architecture of the F7 gene in a Spanish population: implication for mapping complex diseases and for functional assays.

Delineating the genetic variability of loci coding for complex diseases helps to understand the individual variation in disease susceptibility and drug response. We present the allelic architecture of the F7 gene. This gene is the major determinant of FVII plasma levels, and these plasma levels constitute an important intermediate risk factor for cardiovascular disease. As part of the Genetic Analysis of Idiopathic Thrombophila Project, we completely re-sequenced the F7 locus (promoter, exons, introns, and 3'-untranslated region) in 40 unrelated individuals. We found 49 polymorphisms with only two amino acid changes suggesting that regulatory non-coding and intronic variants are responsible for the FVII variability. These results are important for mapping susceptibility alleles of complex diseases, because differences in pair-wise linkage disequilibrium patterns between DNA variants and haplotype frequency distributions may help to detect disease-associated alleles. In addition, we present the results of an in silico search that established genomic comparisons among different species. In conclusion, our study of the F7 DNA sequence variations is an example of a strategy for analyzing the genetic architecture of a quantitative trait locus. Furthermore, it provides a model for future analyses of genetic factors that contribute to the susceptibility of complex diseases in humans.

Contribution of prothrombin 20210A allele and factor V Leiden mutation to thrombosis risk in thrombophilic families with other hemostatic deficiencies.

BACKGROUND AND OBJECTIVES: The aims of this study were to compare the lifetime probability of developing thrombosis in 722 relatives of 132 thrombophilic families of symptomatic probands with recognized thrombophilic defects and to determine the prevalence of the factor V Leiden (FVL) mutation and the 20210A allele of the prothrombin gene (PT20210A) in these families. DESIGN AND METHODS: The study included 722 members belonging to 132 unrelated families. The propositi were patients who had been referred to our Thrombosis Unit. The families were selected through a symptomatic proband. Once a patient with a deficiency or mutation was identified, family members were screened for the same defect. RESULTS: The prevalence of FVL and PT20210A in families with other thrombophilic defects was higher than expected. Compared with non-deficient individuals, the risk of venous thrombosis was increased in subjects with antithrombin (AT), protein S (PS) and protein C (PC) deficiencies, and in carriers of FVL and PT20210A mutations. The risk of thrombosis was significantly increased for individuals with combined genetic defects (PC-FVL, PS-FVL, PS-PT20210A and FVL-PT20210A). The ages at the time of 50% thrombosis-free survival were as follows: 34 years for AT deficiency, (19 years with FVL, 21 years with PT20210A), 62 years for PC deficiency (33 years with FVL, 44 years with PT20210A), 37 years for PS deficiency (24 years with FVL, 36 years with PT20210A), 50 years for the FVL mutation (52 years with PT20210A), and 65 years for the PT20210A mutation. As for clinical characteristics, no differences were observed except for the higher frequency of oral contraceptive-related thrombosis in women who were carriers of PT20210A or FVL. INTERPRETATION AND CONCLUSIONS: Based on these results, screening for FVL and PT20210A mutation is recommended in patients with other thrombophilic defects. To the best of our knowledge, this is the first family study, including the PT20210A mutation, that compares genetic risk factors for thrombosis and the lifelong probability of developing thrombosis.

[Treatment with sildenafil and satisfaction with life in depressive patients with erectile dysfunction]. / Tratamiento con sildenafilo y satisfacción con la vida en pacientes depresivos con disfunción eréctil.

INTRODUCTION: To evaluate the effectiveness of Sildenafil in the treatment of erectile dysfunction (ED) in patients with depression; and the satisfaction with differents aspects of life. METHODS: A multicenter, observational, prospective and non-comparative study conducted in primary care units. Effectiveness was measured by the questionnarie International Index of Erectile Function (IIEF), satisfaction with life by the Life Satisfaction Check-List (LSCL), and partner's satisfaction by Satisfaction with treatment of erectile dysfunction (EDITS). The study enrolled 330 patients with ED and Depression, treated with 50 mg (adjusted to 25/100 mg according to response) of Sildenafil for at least 10 weeks. RESULTS: The erections improved for the 84.2%. At the initial visit a 58.2% had a severe dysfunction, and at the post-treatment visit for the 41.2% of the sample, the dysfunction was light. The most important increase in the LSCL was sexual activity and partner relationship. CONCLUSIONS: Significant increases were observed in the LSCL was sexual activity and partner relationship.

Tratamiento con sildenafilo y satisfacción con la vida en pacientes depresivos con disfunción eréctil / Treatment with sildenafil and satisfaction with life in depressive patients with erectile dysfunction

Introducción: Actualmente la disfunción eréctil (DE) se considera un problema de salud pública. Sabemos que la DE y la depresión están muy relacionadas, por tanto se plantea como objetivo del estudio evaluar la efectividad de Sildenafilo para el tratamiento de la disfunción eréctil (DE) en pacientes con depresión, conociendo los efectos del tratamiento sobre la satisfacción con distintos aspectos de la vida. Material y método: Se realizó un estudio prospectivo, observacional no comparativo y multicéntrico, en el que se utilizaron tres cuestionarios validados: el Índice Internacional de Función Eréctil (IIEF), Life Satisfaction Check-List (LSCL) y el Índice de Satisfacción con el tratamiento para la Disfunción Eréctil, versión para la pareja (EDITS), para evaluar diferentes aspectos del tratamiento con Sildenafilo. La muestra incluyó un total de 330 pacientes con DE y depresión tratados con 50 mg de Sildenafilo, con posible ajuste a 25/100 mg, durante al menos un período de 10 semanas. Resultados: En un 84,2 por ciento se observó mejoría en sus erecciones. Según el IIEF, en la visita basal el 58,2 por ciento presentaba DE severa, frente al 41,2 por ciento con DE leve tras el tratamiento. La satisfacción con los aspectos de la vida analizados, presentó incrementos significativos tras la toma de sildenafilo (p< 0,001), especialmente los relacionados con la vida sexual y relación de pareja. Conclusiones: Se observaron incrementos significativos en la satisfacción con todos los aspectos de la vida analizados, especialmente en la vida sexual y relación de pareja (AU)

Educational differences in health expectancy in Madrid and Barcelona.

Educational differences in Health Expectancy (HE) among residents older than 24 years of age in Madrid and Barcelona are evaluated. Death records were linked to the 1991 Population Census and self-perceived health from the National Health Interview Survey was used. Differences between the higher and the lower educational groups in HE at 25 years were: 7.5 years in men and 5.58 years in women in Madrid and 9.5 years in men and 13.4 years in women in Barcelona. Since HE combines mortality and health status, results presented may have important implications for health policy.

Efectividad del tratamiento con sildenafilo en pacientes con disfunción eréctil e hipertensión arterial / Efficiency of treatment with sildenafil in patients with erectile dysfunction and arterial hypertension

Objetivo. Evaluar la efectividad de sildenafilo para el tratamiento de la disfunción eréctil (DE) en pacientes con hipertensión arterial (HTA), conociendo los efectos del tratamiento sobre la satisfacción con distintos aspectos de la vida y la satisfacción de la pareja con el tratamiento. Material y métodos. Se realizó un estudio prospectivo, observacional no comparativo y multicéntrico, en el que se utilizaron tres cuestionarios validados: el Índice Internacional de Función Eréctil (IIEF), Life Satisfaction Check-List (LSCL) y el Índice de Satisfacción con el tratamiento para la Disfunción Eréctil, versión para la pareja (EDITS), para evaluar diferentes aspectos del tratamiento con sildenafilo. La muestra incluyó un total de 770 pacientes con DE e HTA tratados con 50 mg de sildenafilo, con posible ajuste a 25/100 mg, durante al menos un período de 10 semanas. Resultados. En un 86,6 por ciento se observó mejoría en sus erecciones. Según el IIEF, en la visita basal el 59,7 por ciento presentaba DE severa frente al 52,4 por ciento con DE leve tras el tratamiento. El mayor incremento detectado en el LSCL fue en la vida sexual (35,4 por ciento) y la vida en pareja (17,8 por ciento). El 61,2 por ciento de las parejas se mostró muy satisfecha con el tratamiento con sildenafilo. Conclusiones. Se observaron incrementos significativos en todas las dimensiones del IIEF, en los aspectos relacionados con la vida del LSCL y en la satisfacción de la pareja con el tratamiento, con independencia del fármaco antihipertensivo utilizado (AU)

[The telephone accessibility of the prior appointment program]. / Accesibilidad telefónica del programa de cita previa.

OBJECTIVE: To determine the ease of access by telephone when making medical appointments. DESIGN: Cross-sectional, observational, random sample. SETTING: Primary care, Murcia Region. PATIENTS AND OTHER PARTICIPANTS: Centres with a previous appointments system (n = 25) and a random sample of the 276 practitioners involved (n = 97). We ruled out 4 practitioners for not having a telephone in their outer consulting room. MEASUREMENTS AND MAIN RESULTS: We made telephone calls until we had obtained appointments with each of the practitioners, across three hour blocks. The result was an average of 2,333 calls/appointment, with a deflection of 2,271. The mode and median were 1, and the range 26. We found differences in the distribution of the calls across the three blocks (p < 0.05). Comparing rural centres with urban, we found a lower average number of calls in the first two blocks (p < 0.01). CONCLUSIONS: Telephone accessibility is at an appropriate level, both in rural and urban areas.

Insuficiencia respiratoria progresiva del adulto asociada a eclampsia. Presentacion de un casos. / Progressive respiratory insufficiency in adults associated with eclampsia. Report of a case

La incidencia de IRPA es cada vez mayor.Se hace una revision de los mecanismos desencadenantes y de los factores asociados.Debido a los escasos reportes de esta patologia asociada a toxemia grave, se hace la descripcion de un caso y se enfantiza en los principales puntos del tratamiento

[Sudden death in the long term development of ischemic cardiopathy]. / La muerte súbita en la evolución a largo plazo de la cardiopatía isquémica.

During five years or until death, we had under observation 74 patients who survived the acute phase of myocardial infarction, 66 patients with angor inestable, and a third group, also of 66 patients of the coronary unit, but whose cases didn't show evidence of their illness being due to myocardial infarction. The general features were similar in the three groups. The patients outliving myocardial infarction reached 69%; those surviving angor inestable, reached 79%, and the survivors of the no-coronary group, 92.5%. There were not significant differences among the three groups in mortality rate due to non cardial illnesses. The differences are in relation with sudden death; in the first groups, 14.8%, 10.6% in the second group, and only 1.5% in the third one. In the coronary groups half the total mortality was due to sudden death. Death was instantaneous in 26% of the cases and 52% occurred in less than two hours. All of these sudden deaths occurred out of the Hospital. Patients with antecedents of previous myocardial infarction showed from 3 to 6 more sudden deaths than those patients suffering a first myocardial infarction. The myocardial infarction patients who developed cardiomegaly afterwards registered two and a half more sudden deaths than those without cardiomegaly. Differences were highly significant; 28.5% sudden deaths in those patients with cardiomegaly and 8.4% in patients without cardiomegaly. These results show that the higher rate of sudden deaths is due to a more extensive myocardial damage. Arterial hypertension also constitutes and important risk of sudden death, even when it is properly controlled after the acute period.

[Fixed fibrous subaortic stenosis. Postoperative evaluation]. / Estenosis subaórtica fibrosa fija Valoración postoperatoria.

Fibrous sub-aortic stenosis in 19 patients surgically treated is discussed. The clinical, radiologic, EKG and cardiac catheterization data in the pre and post-operative evaluations are reviewed. There were no surgical deaths in this series. In 14 cases post-operative cardiac catheterization was carried out, in 11 patients a significant decrease in the gradient was found. In 4 cases pharmacological testing was done during catheterization before and after surgery, without significant change in gradients.