Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis.

OBJECTIVES: To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO). METHODS: A retrospective clinical study and blinded radiological review of adult patients with VO. RESULTS: Eighty-eight patients were included: 57 (65%) had a definitive diagnosis of VO (positive microbiology), and 31 (35%) had a probable diagnosis of VO. Of these, 27 (30.7%) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2%). Patients with VF were considered to be at higher risk of osteopenia--they were older (74 vs 66 years, p = 0.013), and included high percentage of women (33 vs 41%, NS)--; and presented more dorsal involvement (56 vs 21%; p < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days, p = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF). CONCLUSIONS: VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.

Granulomatous cutaneous sarcoidosis: diagnosis, relationship to systemic disease, prognosis and treatment.

Sarcoidosis is an antigen-mediated disease of unknown aetiology, characterized by the presence of non-caseating epithelioid cell granulomas in multiple organs. Cutaneous involvement in sarcoidosis is classified as specific, when biopsy reveals non-caseating granulomas, and non-specific, typically erythema nodosum. Granulomatous skin lesions occur in 9% to 37% of patients. The skin is the second most commonly involved organ after the lung. A skin biopsy is easy to perform and enables an early diagnosis with a minor invasive procedure. Some types of specific lesions have prognostic significance and may help to predict the outcome of the systemic disease. Maculopapules, subcutaneous nodules and scar sarcoidosis are usually transient or tend to follow the course of the systemic disease. Skin plaques and lupus pernio are associated with chronic sarcoidosis. Although most cutaneous lesions of sarcoidosis do not cause significant morbidity and do not require treatment, some have cosmetic importance because they may be disfiguring and can have a strong psychosocial impact. Treatment of these lesions is a challenge since they do not respond well to conventional treatments. This manuscript reviews the clinical characteristics of the more frequent types of specific cutaneous lesions of sarcoidosis, the relationship between cutaneous involvement and systemic disease, the prognostic significance of lesions and the present state of treatment of difficult cases of cutaneous sarcoidosis.

Rainfall is a risk factor for sporadic cases of Legionella pneumophila pneumonia.

It is not known whether rainfall increases the risk of sporadic cases of Legionella pneumonia. We sought to test this hypothesis in a prospective observational cohort study of non-immunosuppressed adults hospitalized for community-acquired pneumonia (1995-2011). Cases with Legionella pneumonia were compared with those with non-Legionella pneumonia. Using daily rainfall data obtained from the regional meteorological service we examined patterns of rainfall over the days prior to admission in each study group. Of 4168 patients, 231 (5.5%) had Legionella pneumonia. The diagnosis was based on one or more of the following: sputum (41 cases), antigenuria (206) and serology (98). Daily rainfall average was 0.556 liters/m(2) in the Legionella pneumonia group vs. 0.328 liters/m(2) for non-Legionella pneumonia cases (p = 0.04). A ROC curve was plotted to compare the incidence of Legionella pneumonia and the weighted median rainfall. The cut-off point was 0.42 (AUC 0.54). Patients who were admitted to hospital with a prior weighted median rainfall higher than 0.42 were more likely to have Legionella pneumonia (OR 1.35; 95% CI 1.02-1.78; p = .03). Spearman Rho correlations revealed a relationship between Legionella pneumonia and rainfall average during each two-week reporting period (0.14; p = 0.003). No relationship was found between rainfall average and non-Legionella pneumonia cases (-0.06; p = 0.24). As a conclusion, rainfall is a significant risk factor for sporadic Legionella pneumonia. Physicians should carefully consider Legionella pneumonia when selecting diagnostic tests and antimicrobial therapy for patients presenting with CAP after periods of rainfall.

Predictors of cognitive decline in 85-year-old patients without cognitive impairment at baseline: 2-year follow-up of the octabaix study.

BACKGROUND/RATIONALE: To determine how many 85-year-old community-dwelling patients with good cognitive performance at baseline maintain this level at 2-year follow-up. METHODS: We realized a longitudinal community-based study including 169 inhabitants. Patients who maintained scores >23 on the Spanish version of the Mini-Mental State Examination (MEC) were compared with the rest. RESULTS: A total of 144 individuals (85.2%) were found maintaining a MEC score >23. Under the combined criteria 110 (65%) presented no new cognitive decline. Multiple logistic regression analysis showed that maintaining a MEC score >23 was significantly associated with having a higher MEC score at baseline (P < .001, odds ratio 1.280, 95% confidence interval 1.104-1.484). CONCLUSION: Most oldest-old patients with good cognitive function at baseline maintain this level at 2-year follow-up.