Impact of the COVID-19 pandemic on osteoporotic hip fractures in Chile.

The study analyzes whether the COVID-19 pandemic affects annual hip fractures (HF) rates and weekly emergency department (ED) consultations and hospitalizations due to trauma in older people. During the COVID-19 pandemic, HF rates and ED consultation and hospitalization rates due to trauma decreased. PURPOSE: To describe the effect of the COVID-19 pandemic on annual HF rates and weekly ED consultation and hospitalization rates due to trauma in Chile in 2020, compared to 2016-2019. METHODS: A retrospective study was conducted based on data from Chile's Department of Statistics and Health Information. Annual HF admissions, weekly ED consultations and hospitalizations due to trauma were described for the years 2016-2020, grouping the years 2016-2019 to compare them with 2020. Rates were calculated per 100.000 inhabitants. RESULTS: From 2016 to 2020, a total of 35.050 patients aged ≥ 65 years were hospitalized in Chile with a diagnosis of HF, with the lowest number of admissions in 2020 (6.423). During 2020, annual HF rate was 273.6/100.000, representing a decrease of 18.5% compared to the average annual HF rate of 2016-2019 (335.7/100.000). In 2020, the weekly consultation rate due to trauma in older adults decreased by 20.8% and the weekly hospitalization rate due to trauma in older adults decreased by 18.5%. CONCLUSION: During the COVID-19 pandemic, osteoporotic HF rates decreased, along with ED consultation and hospitalization rates due to trauma in older adults. This could be a result of mobility restrictions and a significant increase in the proportion of self-reliant older adults in the Chilean population.

The Association of Human Astrovirus with Extracellular Vesicles Facilitates Cell Infection and Protects the Virus from Neutralizing Antibodies.

Viral gastroenteritis has a global distribution and represents a high risk for vulnerable population and children under 5 years due to acute diarrhea, fever and dehydration. Human astroviruses (HAstV) have been identified as the third most important cause of viral gastroenteritis in pediatric and immunocompromised patients. Furthermore, HAstV has been reported in biopsies taken from patients with encephalitis, meningitis and acute respiratory infection, yet it is not clear how the virus reaches these organs. In this work we have tested the possibility that the released astrovirus particles could be associated with extracellular vesicles. Comparison between vesicles purified from HAstV Yuc8 infected and mock-infected cells showed that infection enhances production of vesicles larger than 150 nm. These vesicles contain CD63 and Alix, two markers of vesicular structures. Almost 70% of the extracellular virus present in clarified supernatant at 18 h postinfection was found associated with vesicular membranes, and this association facilitates cell infection in the absence of trypsin activation and protects virions from neutralizing antibodies. Our findings suggest a new pathway for HAstV spread and might represent an explanation for the extra-intestinal presence of some astrovirus strains. IMPORTANCE Astroviruses are an important cause of diarrhea in vulnerable population, particularly children; recently some reports have found these viruses in extra-intestinal organs, including the central nervous system, causing unexpected clinical disease. In this work, we found that human astrovirus strain Yuc8 associates with extracellular vesicles, possibly during or after their cell egress. The association with vesicles doubled astrovirus infectivity in less susceptible cells and rendered virus particles insensitive to neutralization by antibodies. These data suggest that extracellular vesicles could represent a novel pathway for astrovirus to disseminate outside the gastrointestinal tract.

Decreasing hip fracture rates among older adults in Chile, 2001-2019.

Our aim was to analyze trends in hip fracture rates in people aged ≥ 65 years, from 2001 to 2019 in Chile. Age-standardized incidence rates decreased significantly in both genders over the study period. PURPOSE: To describe and analyze the characteristics and trends of osteoporotic hip fractures in Chile from 2001 to 2019, by age and sex. METHODS: We assessed hip fractures in people aged ≥ 65 years using data from the hospital discharge register of Chile's Department of Statistics and Health. The Joinpoint regression analysis software was used to perform a trend analysis. RESULTS: From 2001 to 2019, a total of 107.972 patients aged ≥ 65 years were hospitalized in Chile with a diagnosis of hip fracture (S72.0, S72.1, and S72.2). 77.4% of the patients were females, and 63.7% were adults aged ≥ 80 years. The average annual incidence rate over this period was 358.3/100.000 in the whole population (95% CI: ± 12.8), 195.2/100.000 in men (95% CI: ± 9), and 482/100.000 in women (95% CI: ± 15.5). After an adjustment for age, hip fracture rates decreased annually on average by 1.0% (p < 0.001, 95% CI: - 1.4%, - 0.7%), from 358.5/100.000 in 2001 to 331.7/100.000 in 2019. Hip fracture rates decreased annually in both men (- 1.4%, p < 0.001) and women (- 0.9%, p < 0.001). CONCLUSION: The incidence of osteoporotic hip fractures has been decreasing annually and significantly in Chile since 2001, both in men and women. This may be caused by increased levels of obesity and a lower risk of falling among older adults. We recommend further studies to assess all factors contributing to this change in hip fracture rates.

Rotaviruses Associate with Distinct Types of Extracellular Vesicles.

Rotaviruses are the leading cause of viral gastroenteritis among children under five years of age. Rotavirus cell entry has been extensively studied; however, rotavirus cell release is still poorly understood. Specifically, the mechanism by which rotaviruses leave the cell before cell lysis is not known. Previous works have found rotavirus proteins and viral particles associated with extracellular vesicles secreted by cells. These vesicles have been shown to contain markers of exosomes; however, in a recent work they presented characteristics more typical of microparticles, and they were associated with an increase in the infectivity of the virus. In this work, we purified different types of vesicles from rotavirus-infected cells. We analyzed the association of virus with these vesicles and their possible role in promotion of rotavirus infection. We confirmed a non-lytic rotavirus release from the two cell lines tested, and observed a notable stimulation of vesicle secretion following rotavirus infection. A fraction of the secreted viral particles present in the cell supernatant was protected from protease treatment, possibly through its association with membranous vesicles; the more pronounced association of the virus was with fractions corresponding to cell membrane generated microvesicles. Using electron microscopy, we found different size vesicles with particles resembling rotaviruses associated from both- the outside and the inside. The viral particles inside the vesicles were refractory to neutralization with a potent rotavirus neutralizing monoclonal antibody, and were able to infect cells even without trypsin activation. The association of rotavirus particles with extracellular vesicles suggests these might have a role in virus spread.

Epidemiology and Direct Medical Cost of Osteoporotic Hip Fracture in Chile.

The osteoporotic hip fracture is associated with a high impact on morbidity, mortality, and health expenditure. The Chilean health system is made up of a mixed care system, with the public system called FONASA and the private system called ISAPRE. The people with lower incomes are listed on FONASA and correspond to 80.8% of the population. The aims of this study were to describe the incidence of hip fracture in the Chilean population from the age of 45 years and to estimate the direct medical cost of this disease. The records of the Department of the Health Statistics and Information of the Ministry of Health were used, from which the number of national hospital discharges due to hip fractures was obtained (codes S720, S721, and S722 of the ICD-10), in adults aged 45 years or older, by sex, from 2006 to 2017. The cost of osteoporotic hip fracture treatment in the public health system was obtained from the data of the surgical treatment according to the payment method associated with diagnosis (PAD bonus). A surgical intervention budget was used in a private clinic to calculate the direct cost of osteoporotic hip fracture in the private system. Between 2006 and 2017, the number of hospital discharges due to osteoporotic hip fracture in adults aged 45 years and older has increased progressively, registering 9.583 hospital discharges for this cause in 2017, which corresponds to 50% more than those recorded in 2006, with a 3 : 1 F/M ratio. The mean annual rate of hip fractures is 148.7 per 100,000 inhabitants aged above 45 years. The individual cost of managing an osteoporotic hip fracture in the public system was USD$ 3,919, and USD$ 9,092 in the private health system. The incidence of hip fracture was comparable with data from Southern European countries and from neighboring countries, such as Argentina and Uruguay. Hospitalization cost of hip fracture in Chile was 34 million USD per year. Hip fracture constitutes a serious healthcare problem in Chile, and efforts for the prevention and management of osteoporosis are needed.

Use of leucaena leaf-meal in the diets for molt induction in laying hens / Utilização do feno da folha da leucena em rações para indução de muda forçada em poedeiras comerciais

This trial was conducted to evaluate the effects of diets containing leucaena leaf-meal in the induction of the molt in laying hens. A group of 180 Hy-Line W36, with 90 weeks of age, was randomly distributed among five treatments with 6 repetitions, each with 6 birds. Treatments consisted of molt induction by the feed withdrawal method and diets containing 25; 50; 75 and 100 % leucaena leaf-meal. The feed withdrawal was applied for 10 days. Feeding molt diet was interrupted as birds in the other treatments reached 24% weight loss, or 21 days. During the induction period, there was a linear reduction of feed intake and a linear increase in weight loss as leucaena leaf-meal increased in the diet. Except for the treatment with 25% of leucaena leaf-meal, birds ceased egg production three days from the beginning of the experiment. Productive performance and egg quality in the postmolt period were not affected by treatments. In conclusion, molt induction using diets containing 50% leucaena leaf-meal or higher showed similar results compared to those obtained with conventional feed withdrawal method.

Este experimento foi conduzido para avaliar os efeitos do uso de rações que continham feno da folha da leucena na indução da muda forçada em poedeiras comerciais. Um grupo de 180 poedeiras Hy-Line W36, com 90 semanas de idade foi distribuído ao acaso em cinco tratamentos com seis repetições de seis aves. Os tratamentos consistiram na indução da muda através do método do jejum e foram utilizadas rações de muda que continham feno da folha de leucena com níveis de inclusão de 25, 50, 75 e 100%. O método do jejum foi aplicado por 10 dias. Nos demais tratamentos a ração de muda foi suspensa quando as aves atingiram 24% de perda do peso inicial, ou no 21º dia. Durante o período de indução da muda houve redução linear no consumo de ração e aumento linear na perda de peso das aves com o aumento da inclusão do feno de leucena na ração, exceto para o tratamento com 25% de feno, onde a produção de ovos cessou três dias após o início do experimento. No período após a muda, o desempenho e a qualidade dos ovos não foram afetados significativamente pelos níveis de inclusão. A inclusão de feno de leucena na ração de muda a partir de 50% produz resultados similares aos do método do jejum.

Use of leucaena leaf-meal in the diets for molt induction in laying hens / Utilização do feno da folha da leucena em rações para indução de muda forçada em poedeiras comerciais

This trial was conducted to evaluate the effects of diets containing leucaena leaf-meal in the induction of the molt in laying hens. A group of 180 Hy-Line W36, with 90 weeks of age, was randomly distributed among five treatments with 6 repetitions, each with 6 birds. Treatments consisted of molt induction by the feed withdrawal method and diets containing 25; 50; 75 and 100 % leucaena leaf-meal. The feed withdrawal was applied for 10 days. Feeding molt diet was interrupted as birds in the other treatments reached 24% weight loss, or 21 days. During the induction period, there was a linear reduction of feed intake and a linear increase in weight loss as leucaena leaf-meal increased in the diet. Except for the treatment with 25% of leucaena leaf-meal, birds ceased egg production three days from the beginning of the experiment. Productive performance and egg quality in the postmolt period were not affected by treatments. In conclusion, molt induction using diets containing 50% leucaena leaf-meal or higher showed similar results compared to those obtained with conventional feed withdrawal method.

Este experimento foi conduzido para avaliar os efeitos do uso de rações que continham feno da folha da leucena na indução da muda forçada em poedeiras comerciais. Um grupo de 180 poedeiras Hy-Line W36, com 90 semanas de idade foi distribuído ao acaso em cinco tratamentos com seis repetições de seis aves. Os tratamentos consistiram na indução da muda através do método do jejum e foram utilizadas rações de muda que continham feno da folha de leucena com níveis de inclusão de 25, 50, 75 e 100%. O método do jejum foi aplicado por 10 dias. Nos demais tratamentos a ração de muda foi suspensa quando as aves atingiram 24% de perda do peso inicial, ou no 21º dia. Durante o período de indução da muda houve redução linear no consumo de ração e aumento linear na perda de peso das aves com o aumento da inclusão do feno de leucena na ração, exceto para o tratamento com 25% de feno, onde a produção de ovos cessou três dias após o início do experimento. No período após a muda, o desempenho e a qualidade dos ovos não foram afetados significativamente pelos níveis de inclusão. A inclusão de feno de leucena na ração de muda a partir de 50% produz resultados similares aos do método do jejum.

Low bone mineral density in rotating-shift workers.

Shift workers have been reported to have an increased bone resorption. However, no existing evidence indicates lower bone mineral density (BMD) in this group. The objective of this study was to test the hypothesis that a rotating-shift work schedule is associated with low BMD and osteoporosis. We evaluated 70 postmenopausal nurses from the Naval Hospital in Concepcion, Chile. The participants were categorized according to the type of work schedule: 39 had a rotating shift and 31 were daytime workers. Medical history, a health examination, a questionnaire on health-related behaviors and biochemical determinations, and BMD examination were obtained for all participants. When comparing the 2 groups, the rotating-shift workers had lower BMD in the lumbar spine (L1-L4: 0.957 ± 0.15 vs 1.104 ± 0.13; p<0.05) and lower bone density in both femoral neck bones (right: 0.936 ± 0.17 vs 1.06 ± 0.12; p<0.05 and left: 0.956 ± 0.19 vs 1.05 ± 0.12; p<0.05). Additionally, the T-scores for 10 (25.6%) of the rotating-shift workers indicated osteoporosis at lumbar spine (T-score>-2.5). No evidence of osteoporosis was found for daytime workers. When comparing the 2 groups, the rotating-shift workers had a higher prevalence of osteopenia (T-score=-1.0 to -2.5) than the daytime workers: 46.2% vs 35.5%, respectively. We found significant evidence that rotating-shift workers have lower BMD in the trabecular and cortical bones, thus suggesting that this type of work may be a risk factor for osteoporosis. Because this is the first time that this osteoporosis risk factor has been reported, the association needs to be replicated and confirmed in other settings.

[Acquired von Willebrand disease as an unusual manifestation of primary hypothyroidism: report of two cases]. / Enfermedad de von Willebrand como manifestación clínica inhabitual del hipotiroidismo primario. Caso clínico.

Patients with hypothyroidism may have a minor increase in their bleeding tendency, causing easy bruising and menorrhagia. There is a positive correlation between factor VIII coagulant activity and thyroxin serum levels. Thus, patients with hypothyroidism have an acquired coagulation defect that is reversible with thyroxin supplementation. We report two sisters, aged 13 and 11 years, who met the criteria for von Willebrand's disease at the age of eight. Both sisters had a primary hypothyroidism due to Hashimoto's thyroiditis, diagnosed three years later. Thyroid hormone replacement normalized von Willebrand factor, factor VIII, and the bleeding diathesis disappeared. Acquired von Willebrand's disease is an unusual manifestation of hypothyroidism. However the possibility of hypothyroidism should be considered in patients presenting with von Willebrand disease.

[Reproductive history of women consulting in emergency services in a southern region of Chile]. / Características reproductivas de las mujeres consultantes en servicios de urgencia general de la VIII Región.

BACKGROUND: The occurrence and timing of menstrual and reproductive events such as menarche, regularity of menses, births, maternal breastfeeding and menopause play an important role in a woman's life. AIM: To study the variability of reproductive live from menarche to menopause in different age groups in Chilean Caucasian and Mapuche aborigine females in a southern location of Chile. SUBJECTS AND METHODS: A questionnaire about reproductive history was answered by 502 women consulting in six general emergency rooms of different public hospitals of the 8th region of Chile, between May and September 2002. RESULTS: The median age at menarche was 12.8 years among adolescents and 13.7 years among older women (p <0.001). Fecundity rate was 5.2, 3.9 and 1.8 among older women, adults and young adults, respectively. Forty seven percent of adolescent had at least one child. The median age for natural menopause was 47 years. Eighty one percent of older women and 65% of adult women had given breastfeeding for more than six months. No statistical differences in reproductive characteristics were observed between Chilean Caucasians and Mapuche aborigines. CONCLUSIONS: Among these women, the age of menarche in younger women is similar to that of women from industrialized countries. Fecundity has been progressively decreasing. Menopause tends to occur sooner than in other geographical regions, probably due to the high number of surgical sterilizations in our population. Adolescent pregnancy still is a problem.

[Poems syndrome. Report of one case]. / Síndrome de Poems: caso clínico.

Poems syndrome (polyneuropathy, organomegaly, endocrine abnormality, M-protein, plasma cell dyscrasia, and skin lesions) is a plasma cell dyscrasia whose pathogenesis is unknown. We report a 60 years old woman that presented a tetraparesis caused by a sensitive motor polyneuropathy. The subsequent work up revealed an IgA type monoclonal gammopathy, hepatomegaly, hyperestrogenism, primary adrenal failure, hypothyroidism, hyperpigmentation and erythematous lesions in the skin and ankle edema. The patient is being treated with prednisone 0.5 mg/kg and levothyroxine 100 microg/day, with partial remission of her symptoms.

[Somatotropic pituitary tumor in a patient with a previous ovarian strumal carcinoid. Report of one case]. / Adenoma hipofisiario productor de somatotrofina en una paciente con antecedente de struma ovarii carcinoide.

Strumal carcinoid is an unusual form of monodermal ovarian teratoma with thyroid-like follicles mixed with typical carcinoid tumor patterns. We report a 49 years old woman presenting with an acromegaly. At the age of 45, an ovarian strumal carcinoid was excised and at three years of follow up, she complained of finger and feet growth. Laboratory showed an elevated serum IGF-1 and a sella turcica magnetic resonance imaging showed an 8 mm microadenoma. She was subjected to a transphenoidal excision and the pathological study disclosed a solid acidophilic pituitary adenoma. Two months after surgery, there was a significant decrease in serum IGT-I levels.

[Anti thyroglobulin antibodies in the follow up of patients with differentiated thyroid cancer: residual or relapsing disease markers?]. / Anticuerpos anti-tiroglobulina en el seguimiento de pacientes con cáncer diferenciado de tiroides: marcadores de enfermedad residual o recidivante?

BACKGROUND: Anti thyroglobulin antibodies are present in 25% of patients treated for a differentiated thyroid cancer, invalidating thyroglobulin determination. Those patients subjected to total thyroidectomy and free of disease, should reduce the production of these antibodies, due to the lack of antigenic stimulus. Therefore, anti thyroglobulin antibodies could be useful to detect early relapses. AIM: To assess the relationship between anti thyroglobulin antibodies and the evolution of the disease in patients treated for thyroid cancer. MATERIAL AND METHODS: Retrospective analysis of 26 patients treated for thyroid cancer with positive anti thyroglobulin antibodies, followed for three years. These were divided in those with or without lymphocytic thyroiditis (19 and 7 respectively). RESULTS: At the first year of follow up, anti thyroglobulin antibody concentration was 401 +/- 94.9 UI/ml (x +/- sem) in patients with thyroiditis and 38.9 +/- 8.9 UI/ml in those without thyroiditis (p < 0.005). During the three years of follow up, no differences in anti thyroglobulin antibodies were observed between patients with or without tumor relapse. CONCLUSIONS: Concentration of anti thyroglobulin antibodies was higher in patients with thyroiditis and did not differentiate patients with tumor relapse.