Disability and quality of life in heart failure patients: a cross-sectional study.

BACKGROUND: Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life. AIM: To assess the degree of disability and quality of life in HF patients attended at family medicine centres. DESIGN AND SETTING: Cross-sectional study of a cohort of HF patients attended at family medicine centres. METHODS: Disability was assessed with the WHODAS 2 questionnaire, which provides a global and six domain scores that is understanding and communication, getting around, self-care, getting along with people, life activities and participation in society. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, which furnishes a global and two domain scores, physical and emotional. RESULTS: A breakdown of the results showed that 28% of patients had moderate disability and 16.7% had severe disability, with the most important areas affected being: life activities, 8.9% extreme disability and 30.3% severe disability; getting around, 34.6% severe disability and 2% extreme disability; and participation in society, 53.3% moderate-severe disability. Quality of life was mildly affected. New York Heart Association (NYHA) Functional Classification and sex were the major determinants of disability and quality of life. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists were associated with better scores in the "getting around" and "life activity" domains. CONCLUSION: HF patients in primary care show an important degree of disability and an acceptable quality of life.

Local Application of Growth Hormone to Enhance Osseointegration in Osteoporotic Bones: A Morphometric and Densitometric Study.

PURPOSE: The aim of this study was to assess the effect of local application of growth hormone on osseointegration of dental implants inserted in osteoporotic bones. MATERIALS AND METHODS: Twenty female New Zealand rabbits were used in this study. Ten were ovariectomized and fed a low-calcium diet for 6 weeks, and the others remained intact. A titanium implant was inserted into each tibia, in both groups. In half of the rabbits, 2 IU of growth hormone was placed into the ostectomy prior to the implant insertion. Two weeks after implant surgery, all animals were sacrificed. Tibiae were dissected from soft tissues, and included in methacrylate to be studied under light microscopy. Bone-to-implant contact (BIC) and bone mineral density (BMD) were measured by morphometric and densitometric analysis, respectively. Multifactorial analysis of variance (ANOVA) was used for statistical evaluation. P < .05 was considered to be significant. RESULTS: Ovariectomy induced less BIC and BMD in regions closer to the implant compared with the control group. Local application of growth hormone was able to increase the BIC in the ovariectomized group, with statistically significant differences with respect to the control group (P < .01). Regarding the BMD, no statistically significant differences were found. CONCLUSION: Within the limitations of this experimental study, local application of 2 IU of recombinant human growth hormone at the moment of titanium implant insertion in rabbit tibiae significantly enhanced the BIC around titanium implants 15 days after the implantation in this experimental osteoporotic animal model, without affecting the BMD.

Estado nutricional del paciente en hemodiálisis y factores asociados / Nutritional status of the patient on hemodialysis and associated factors

Introducción: La desnutrición en pacientes crónicos en diálisis tiene una alta prevalencia e importante repercusión en la morbimortalidad. Dado que no existen estudios previos en nuestro servicio, planteamos un estudio cuyo objetivo es evaluar el estado nutricional y los factores asociados. Material y Método: Estudio descriptivo, observacional, transversal, el segundo trimestre de 2015, en los pacientes en programa de hemodiálisis de un hospital comarcal. Se registró la edad, sexo, I. de Charlson, técnica de diálisis, IMC, tiempo en diálisis, albúmina, PCR, colesterol y transferrina séricas. Se utilizó como instrumento la Valoración global subjetiva y el Score Malnutrición Inflamación. Resultados: Se analizaron 35 pacientes, la edad media fue 72,2 años (DS: 11,8), 34,3% fueron mujeres, el IMC es 27,1 (DS: 4,9), I. de Charlson 6,4 (DS: 1,7), 77,1% hacían diálisis convencional y 22,9% hemodiafiltración en línea. Según el test MIS el 46% tenía buen estado nutricional y 54% estaba mal nutrido. Según la VGS 66% tenía buen estado nutricional, 31% riesgo de desnutrición y 3% desnutrición severa. La VGS se relaciona con el IMC (p: 0,02), creatinina (p: 0,001), colesterol total (p: 0,02) y PCR (p: 0,01); no con la edad, tiempo en hemodiálisis, I. Charlson, transferrina y albúmina(p> 0,05). El Score Malnutrición Inflamación (MIS) se relaciona con el IMC (p: 0,002), I. Charlson (p: 0,01), creatinina (p: 0,009) y PCR (p: 0,02); no con la edad, tiempo en hemodiálisis, colesterol total, transferrina y albúmina (p> 0,05). Conclusión: Existe buena correlación entre las dos herramientas y los parámetros analíticos utilizados. Los pacientes en hemodiafiltración en línea tienen buen estado nutricional. No existe un único parámetro que valore la nutrición. Se sugiere que es necesaria la valoración nutricional dada la alta prevalencia que existe (AU)

Introduction: Malnutrition in chronic dialysis patients has a high prevalence and important repercussion in morbidity and mortality. Since there are no previous studies in our service, we propose a study whose objective is to evaluate the nutritional status and associated factors. Material and Method: A descriptive, observational, cross-sectional study, in the second trimester of 2015, in patients in the hemodialysis program of a county hospital. Age, sex, Charlson’s index, dialysis technique, BMI, time on dialysis, albumin, CRP, cholesterol and serum transferrin were recorded. Subjective global assessment and Score Malnutrition Inflammation were used as instrument. Results: We analyzed 35 patients, mean age was 72.2 years (SD: 11.8), 34.3% were women, BMI was 27.1 (SD: 4.9), Charlson index 6.4 (DS: 1.7), 77.1% were on conventional dialysis and 22.9% were on-line hemodiafiltration. Regarding the MIS test, 46% had good nutritional status and 54% were malnourished. According to the VGS, 66% had good nutritional status, 31% risk of malnutrition and 3% severe malnutrition. VGS was related to BMI (p: 0.02), creatinine (p: 0.001), total cholesterol (p: 0.02), and CRP (p: 0.01); and it was not related to age, time on hemodialysis, Charlson’s index, transferrin and albumin (p> 0.05). The Score Malnutrition Inflammation (MIS) was related to BMI (p: 0.002), Charlson’s index (p: 0.01), creatinine (p: 0.009) and CRP (p: 0.02); not with age, time on hemodialysis, total cholesterol, transferrin and albumin (p> 0.05). Conclusions: There is good correlation between the two tools and analytical parameters used. Patients in on-line hemodiafiltration have good nutritional status. There is no single parameter that evaluate nutrition. The inclusion of nutritional assessment is suggested given the high prevalence (AU)

Validation of an osteoporotic animal model for dental implant analyses: an in vivo densitometric study in rabbits.

PURPOSE: The achievement of primary stability in porous and soft bone, where implants are more likely to fail, is one of the unresolved challenges of implant dentistry. Therefore, the aim of the study was to validate an osteoporotic animal model for analysis of poor-quality bone. MATERIALS AND METHODS: Sixteen female New Zealand rabbits, each 6 months old and weighing 4 to 5 kg, were used in this study. The animals were anesthetized, and an in vivo densitometric analysis was performed by dual-energy x-ray absorptiometry (DEXA) to measure bone mineral density (BMD) in the calvaria, cervical spine, and tibia. Ovariectomy was then performed, and animals were fed a low-calcium diet that featured 0.07% calcium, rather than the 0.45% calcium of a standard diet, for 6 weeks. After this period, new densitometric measurements were carried out. Two-way analysis of variance was used for statistical evaluation. A P value of less than .05 was considered to be significant. RESULTS: Together, ovariectomy and a low-calcium diet were able to induce a quick decrease in BMD, as measured at 6 weeks by DEXA. This decrease was statistically significant in the calvaria (P < .001) and the cervical spine (P < .05) but not in the tibia. CONCLUSION: Based upon this study, ovariectomy and a low-calcium diet are able to induce experimental osteoporosis in rabbits in a short period of time.

Regeneración tisular en defectos óseos adyacentes a implantes dentales. Estudio morfológico y estructural / Tissue regeneration in bone defects adjacent to dental implants. A morphologic and ultratructural study

Objetivo: este estudio fue realizado para comparar el grado de reparación tisular observado en defectos óseos adyacentes a implantes endostales colocados en tibias de cerdos Material y método: se colocaron 24 implantes en las tibias de tres cerdos, disponiéndose también 24 defectos óseos cilíndricos adyacentes a los 5 mm coronales de cada fijación. De estos defectos, 18 fueron rellenados con hueso liofilizado desmineraliado, hidroxiapatita, o cubiertos con membranas de politetrafluoroetileno expandido. Los animales fueron sacrificados al cabo de 1, 2 y 3 meses. El tejido óseo neoformado fue evaluado mediante análisis morfológico y ultraestructural. Conclusión: los resultados indican que al cabo de 1, 2 y 3 meses de postoperatorio, la densidad ósea fue mayor en defectos óseos tratados con membranas de politetrafluoroetileno expandido (AU)