[Risk of refracture according to the FRAX score in patients older than 50 years who suffer a fracture by a low-impact mechanism]. / Riesgo de refractura según el FRAX score en pacientes mayores de 50 años que sufren una fractura por un mecanismo de bajo impacto.

INTRODUCTION: as the population pyramid inverts, we'll see more old patients suffering a fracture secondary to a low impact mechanism and not all hospitals have a densitometer to make a definitive diagnosis. Nevertheless, we have clinical tools that can help us to start an early treatment. OBJECTIVE: to recognize the risk of re-fracture of patients older than 50 years in our population. MATERIAL AND METHODS: we included all patients older than 50 that suffered a low impact fracture in the Ángeles Mocel Hospital. We used Mexico FRAX score tool to determine de risk of suffering a fracture. The sample was divided in two groups. Utilizing p < 0.05 and a CI of 95%. RESULTS: 69 patients where included. 47.8% had past fractures and only 10% of those had preventive osteoporotic treatment. 50.7% of the patients have a high risk of suffering a mayor osteoporotic fracture in 10 years and 75% of suffering a hip fracture in 10 years. None of the patients received a treatment, either lifestyle modifiers or specific osteoporosis pharmacotherapy at hospital discharge. CONCLUSION: there is a deficiency in the early preventive management of osteoporosis in patients suffering a low impact fracture by orthopedic surgeons.

INTRODUCCIÓN: a medida que se invierte la pirámide poblacional vamos a ver más pacientes que sufren fracturas por mecanismos de bajo impacto y no todos los hospitales cuentan con un densitómetro para hacer el diagnóstico definitivo. Sin embargo, se cuenta con herramientas clínicas que nos apoyan para iniciar con un tratamiento oportuno. OBJETIVO: reconocer el riesgo de refractura que existe en pacientes mayores de 50 años dentro de nuestra población. MATERIAL Y MÉTODOS: se incluyeron a pacientes > 50 años que sufrieron de una fractura de bajo impacto en el Hospital Ángeles Mocel. Usando el FRAX score México para medir el riesgo de sufrir una fractura. Se dividió la muestra en dos grupos, utilizando una p < 0.05 para considerar estadísticamente significativa con un IC de 95%. RESULTADOS: se incluyeron 69 pacientes, 47.8% ya habían sufrido de alguna fractura previa, 10% de ellos tienen tratamiento para la osteopenia. El riesgo de sufrir una fractura mayor osteoporótica en 10 años se observó en 50.7% de los pacientes. El riesgo de sufrir una fractura de cadera en 10 años se encontró en 75% de los pacientes. A ningún paciente se le dio tratamiento, ya sea modificadores del estilo de vida o tratamiento farmacológico para osteopenia/osteoporosis a su egreso hospitalario. CONCLUSIÓN: hay una deficiencia en el manejo inmediato de los cirujanos ortopedistas para prevenir en pacientes futuras refracturas de bajo impacto.

Hybrid inhalable microparticles for dual controlled release of levofloxacin and DNase: physicochemical characterization and in vivo targeted delivery to the lungs.

Current medical treatments against recurrent pulmonary infections caused by Pseudomonas aeruginosa, such as cystic fibrosis (CF) disorder, involve the administration of inhalable antibiotics. The main challenge is, however, the eradication of microbial biofilms immersed in dense mucus that requires high and recurrent antibiotic doses. Accordingly, the development of novel drug delivery systems capable of providing local and controlled drug release in the lungs is a key factor to improve the therapeutic outcome of such therapeutic molecules. Inhalable hybrid carriers were prepared by co-precipitation of CaCO3 in the presence of alginate and the resulting microparticles were treated with alginate lyase (AL) in order to modify their porosity and enhance the drug loading. The hybrid microparticles were loaded with DNase (mucolytic agent) and levofloxacin (LV, wide-spectrum antibiotic) in the range of 20-40% for LV and 28-67% for DNase, depending on the AL treatment. In vitro studies demonstrated that microparticles were able to control the DNase release for 24 h, while 30-50% of LV was released in 3 days. The morphological characterization was performed by optical, fluorescence and scanning electron microscopies, showing a narrow size distribution (5 µm). FTIR, XRD, DSC and nitrogen adsorption isotherm studies revealed the presence of the drugs in a non-crystalline state. A microcidal effect of microparticles was found on P. aeruginosa in agar plates and corroborated by Live/Dead kit and TEM observations. Finally, to study whether the microparticles improved the localization of LV in the lungs, in vivo studies were performed by pulmonary administration of microparticles to healthy mice via nebulization and dry powder inhalation, followed by the quantification of LV in lung tissue. The results showed that microparticles loaded with LV delivered the antibiotic at least 3 times more efficiently than free LV. The developed system opens the gateway to new drug delivery systems that may provide enhanced therapeutic solutions against bacterial infections and in particular as a potential tool in CF pathology.

Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to assess the risk of surgical wound infection and the adverse effects of amoxicillin in healthy patients who required excision of third molars. We identified eligible reports from searches of PubMed, Medline®, the Cochrane Library, Imbiomed, LILACS, and Google Scholar. Studies that met our minimum requirements were evaluated using inclusion and exclusion criteria and the Oxford Quality Scale. Those with a score of 3 or more on this Scale were included and their data were extracted and analysed. For evaluation of the risk of infection the absolute risk reduction, number needed to treat, and 95% CI were calculated. For evaluation of the risk of an adverse effect the absolute risk increase, number needed to harm, and 95% CI were calculated using the Risk Reduction Calculator. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, and estimates of risk (OR) and 95% CI were calculated using the Review Manager 5.3, from the Cochrane Library. A significant risk was assumed when the lower limit of the 95% CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that there was no reduction in the risk of infection when amoxicillin was given before or after operation compared with an untreated group or placebo. In conclusion, this study suggests that amoxicillin given prophylactically or postoperatively does not reduce the risk of infection in healthy patients having their third molars extracted.

Composite scales of morningness and preferences: preliminary validity data in Peruvian undergraduates.

The aim of this study is to offer preliminary results about the validity of the composite morningness scale (CS) and the early/late preferences scale (PS) in a Peruvian sample. The relationship of both scales with the preferred rising and retiring times was analysed, along with the level of self-reported alertness. In Bohle et al.'s (2001) work, the relationship between morningness and preferred rising and retiring times was higher over the weekend than on weekdays. This difference explained the dispositional nature of morningness, due to the possible lesser influence of time schedules over the weekend in individuals' preferences. This result is replicated in a group of 139 Peruvian undergraduates, aged between 18 and 29 years (M = 21.73), of whom 78.4% were women. The relationship between morningness and (actual) normal rising and retiring times on weekdays and over the weekend is considered. The results partially confirm Bohle et al.'s (2001) hypothesis about preferred rising and retiring times and their relationship with the PS, and actual rising time and its relationship with the CS and PS. The differences in the level of self-reported alertness between morning, intermediate and evening-oriented groups provide support for the validity of both scales. Finally, the scores of CS and PS in Peruvian undergraduates are similar to those found by Smith et al. (2002) in university students from six countries.

Primary lung cancer in Mexico city: a report of 1019 cases.

A retrospective study was performed in patients diagnosed with primary lung cancer, and admitted to the Instituto Nacional de Enfermedades Respiratorias between 1984 to 1992. One thousand and nineteen patients were studied, 636 males and 383 females. We found a higher incidence in the group among 61-70 years of age in both sexes. The highest percentage of tumors were from the adenocarcinoma variety, followed by the epidermoid carcinoma, while the small-cell carcinoma presented a lower incidence. Smoking has been associated with the development of lung cancer. Many of our patients were smokers. The highest frequency was in smokers with a smoking habit of more than 30 years and a rate of more than 10 cigarettes per day. However, an important part of the patients with cancer did not have a smoking habit, which led us to believe that there are other etiological possibility factors (genetic or environmental) that could be involved. Most of the cases of cancer were staged as stage IIIb and stage IV and the patients had an ECOG of 1-2. The main symptoms were coughing, sputum, dyspnea and thoracic pain. This data shows an increasing frequency of lung cancer in Mexico city as well as other countries, it also shows that it is going to be a serious health problem in the future. We consider that in order to improve the prognosis, it is necessary to increase the educational and orientation campaigns among the adult population with or without a smoking history.

Use of a mammalian interspersed repetitive (MIR) element in the coding and processing sequences of mammalian genes.

The mammalian interspersed repetitive (MIR) element was amplified in mammals 130 million years ago. The MIR element is at least 260 bp in length and is found in approximately 105 copies in the mammalian genome. We analyzed copies of the MIR element in the DNA of various mammals to determine its relationship to the structure and function of genes, in an attempt to identify specific uses of the MIR element within the mammalian genome. We found that alternative splicing within the acetylcholine receptor gene in humans takes place within the MIR element and results in the incorporation of part of the MIR element into the coding sequence of this gene. Furthermore, the polyadenylation signal (AATAAA) at the 3' end of four different mammalian genes is derived from the MIR element. These uses of the MIR element suggest that other regulatory sequences found within the mammalian genome originated from ancient transposable elements, many of which may no longer be recognizable.

[Evaluation of phagocytosis, bactericidal effect, and cytotoxicity of Pasteurella haemolytica and Pasteurella multocida in bovine alveolar macrophages]. / Evaluación de fagocitosis, efecto bactericida y citotoxicidad de Pasteurella haemolytica y Pasteurella multocida en macrofagos alveolares de bovinos.

Evaluation of phagocytosis and bactericidal effect of Pasteurella haemolytica and P. multocida was conducted on bovine alveolar macrophages freshly obtained through bronchioalveolar washings from live animals. Cytotoxic activity of these bacteria on the alveolar macrophages was evaluated through the simple visual assay in microplates, using bovine blood leukocytes as a comparative target cell. In order to evaluate phagocytosis the following variables were considered P. haemolytica and P. multocida (independently) in contact with alveolar macrophages, P. haemolytica and P. multocida in suspension as a positive control of bacterial growth, and RPMI-1640 medium alone, as a negative control of bacterial growth. To measure bactericidal capacity, bacteria were incubated with plastic adhered alveolar macrophages at 30 minutes and 3 hours intervals. Samples incubated 30 minutes were taken as phagocytosis-base readings and at the 3 h interval to evaluate bactericidal capacity of the alveolar macrophages on phagocytized bacteria. Reading of the samples of each evaluation was conducted in a spectrophotometer a 380 nm. Phagocytosis results indicated that bacterial proliferation was higher when bacteria were alone as compared when they were with alveolar macrophages (p < 0.05). Bactericidal capacity of the macrophages was efficient because bacterial numbers were higher in the first evaluation as compared to the second (p < 0.05). It was demonstrated that the cytotoxic effect of P. haemolytica was more severe on blood leukocytes as compared to alveolar macrophages (p < 0.05). There was no evidence of P. multocida cytotoxicity on the evaluated cells. With the development of this technique for the obtention of alveolar macrophages and using spectrophotometry for the phagocytosis and bactericidal effect evaluations, numerous variables and samples can be tested, such as opsonized bacteria or to measure the behaviour of alveolar macrophages infected with different agents involved in the bovine pneumonic complex.