Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED / Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry

Antecedentes y objetivo La osteoporosis se considera un trastorno generalizado del esqueleto en el que existe una alteración de la resistencia ósea que predispone a la persona a un mayor riesgo de fractura. Este estudio transversal pretende recoger y presentar las principales características clínicas de los pacientes que acuden a la consulta de los médicos internistas en España. Conocer estas características podría facilitar la puesta en marcha de planes de actuación para mejorar la atención de estos pacientes de manera más eficaz y eficiente. Material y métodos A través del análisis del registro OSTEOMED (Osteoporosis en Medicina Interna), este trabajo presenta las principales características clínicas de los pacientes con osteoporosis que acudieron a las consultas de Medicina Interna en 23 centros hospitalarios españoles entre 2012 y 2017. Se han analizado los motivos de consulta, los valores densitométricos, la presencia de comorbilidades, el tratamiento prescrito y otros factores relacionados con el estilo de vida. Resultados En total se evaluó a 2.024 pacientes con osteoporosis (89,87% mujeres, 10,13% hombres). La edad media de los pacientes fue de 64,1 ±12,1 años (mujeres, 64,7 ±11,5 años; hombres, 61,2 ±14,2 años). No hubo diferencia entre sexos en la historia de caídas recientes (9,1-6,7%), mientras que sí se apreció en la ingesta diaria de calcio de lácteos (553,8 ±332,6mg en mujeres vs. 450,2 ±303,3mg en hombres; p <0,001) y en causas secundarias de osteoporosis (13% de hombres vs. 6,5% de mujeres; p <0,001). En la muestra se observaron un total de 404 fracturas (20%) (AU)

Background and objectives Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients’ care more effectively and efficiently. Material and methods Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. Results In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients’ mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001) (AU)

Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. / Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED.

BACKGROUND AND OBJECTIVES: Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS: Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS: In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS: These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.

Evaluación de la litiasis renal asociada a alteraciones metabólicas / Evaluation of renal stones related to metabolic changes

Introducción. Valorar en un grupo de pacientes con litiasis renal y alteraciones metabólicas (hipercalciuria, hiperuricosuria, hipocitraturia, hiperoxaluria), cómo influye el tratamiento médico en el balance metabólico, en el número de eventos clínicos y en la necesidad de procedimientos urológicos, en seguimiento a largo plazo. Material y métodos. Estudio observacional retrospectivo. Los datos se obtuvieron de la revisión de 93 historias clínicas de pacientes que acudieron a consultas externas de medicina interna del Hospital La Princesa, Madrid, entre enero y junio de 2008. Los criterios de inclusión fueron: enfermedad litiásica renal recurrente, alteración metabólica y un mínimo de seguimiento de tres años. Se seleccionaron 68 pacientes. Resultados. Presentan hipercalciuria sola o asociada a otras alteraciones metabólicas 51/68 (75%) pacientes. Nunca habían recibido tratamiento farmacológico 57/68 (83,8%) pacientes. La necesidad de tratamiento instrumental disminuye de forma estadísticamente significativa. Se reduce el número de eventos clínicos y el balance metabólico mejora. Discusión. El tratamiento médico y el seguimiento a largo plazo favorecen la buena evolución clínica y analítica, y disminuyen la necesidad de procedimientos instrumentales (AU)

Introduction. Observational study on a group of patients with renal lithiasis and metabolic changes e.g: hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia. How the medical treatment would influence the restoration of the metabolic balance, the number of symptomatic events; the need for urological surgical procedures; and their long-term follow-up. Material and methods. This observational study was carried out on the data obtained from 93 medical records of patients who attended General Medicine outpatient clinics at La Princesa Hospital in Madrid between January and June 2008. The inclusion criteria were: (1) patient suffering from recurrent renal lithiasis; (2) showing metabolic changes; and (3) under survelliance for 3 or more years. Material and methods. Only 68 patients out of 93 were included in this study. Results. A total of 48/68 (70.6%) patients had hypercalciuria alone or in association with other metabolics changes. 57/68 (83.8%) patients never had appropriate pharmacological treatment. There is a statistically significant reduction in the number of cases treated by surgical procedures. There is also a reduction of clinical events and an improvement in the metabolic balance. Discussion. The medical treatment and long-term survelliance favour the good clinical and biochemical progress, and reduces the need for surgical procedures (AU)

[What is the opinion of Spanish internists on osteoporosis?]. / 'Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE: To conduct an opinion survey on osteoporosis in Spanish internists. METHOD: Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. RESULTS: A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. CONCLUSIONS: The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

¿Qué opinan los internistas españoles de la osteoporosis? / What is the opinion of Spanish internists on osteoporosis?

Objetivo. Realizar una encuesta de opinión sobre osteoporosis en internistas españoles. Método. Encuesta remitida por correo y por visita personal a miembros de la Sociedad Española de Medicina Interna. Recogida de datos sobre opinión acerca de la enfermedad, actitud diagnóstica y terapéutica y medios disponibles (analítica general, radiología convencional, marcadores bioquímicos de remodelamiento óseo, densitometría y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados. Contestaron un total de 538 internistas. Más del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patología prevalente. Más del 80% tiene acceso a una densitometría. Conclusiones. Los internistas españoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ámbito de actuación. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el fármaco de elección y en la práctica totalidad de los casos indican un suplemento de calcio y vitamina D

Objective. To conduct an opinion survey on osteoporosis in Spanish internists. Method. Survey sent by mail and by personal visit to member of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. Results. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to a densitometry. Conclusions. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases

[Descriptive study of 39 cases of hepatic abscess of pyogenic and amebic origin]. / Estudio descriptivo de 39 casos de abscesos hepáticos de origen piógeno (33) y amebiano (6).

Thirty nine cases of liver abscess--33 pyogenic (LAP) and 6 amebic (LAA)--attended in our hospital between 1980 and 1994, were reviewed. Mean patient age was 55.66 years (LAP) and 35.83 years (LAA), while the relation male/female was 2.3:1 and 5:1 respectively. The most usual underlying pathology in LAP was bile duct disease (39.39%). Four patients with LAA had travelled to endemic areas. Fever was the most frequent clinical finding (71.79%). Echography and/or CT scan confirmed the diagnosis in 32 patients (82.05%), with a sensitivity of 86.66 and 95.65% respectively. Positive cultures were found in 74.35% (39.13% polymicrobials), being E. Coli and K. Pneumoniae the most frequently isolated bacteria. In LAP pus cultures were positive in 73% and blood cultures in 55%. Diagnosis of LAA was made by wet mount smears/serology (3/3). Percutaneous drainage was performed in 41.02%, surgical drainage in 48.71 and 15.38% (all with LAP) received antibiotics exclusively. Four patients died (3 with LAP and 1 with LAA).

[Liver disease in patients with human immunodeficiency virus infection. Study of 100 biopsies]. / Affección hepática en pacientes con infección por el virus de la immunodeficiencia humana. Estudio de cien biopsias.

Human immunodeficiency virus (HIV)-related liver disease is frequently diagnosed. We report a study about 100 liver biopsy samples (LB) in patients with HIV infection. The aim of the study has been to analyze the liver biopsy yield when a systemic disease (group A) or a chronic liver disease (group B) are suspected. Tuberculosis, all of them disseminated, was the most common finding in group A biopsy samples, and a 81% yield was obtained. Chronic active hepatitis was the most common finding group B, and profitability reached 90%. We conclude that LB is the elective method to diagnose systemic disease, in patients previously selected according to their clinical findings, and that final diagnoses and safe.