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INTRODUCTION: Hip fracture among older patients is a devastating injury in most cases. It profoundly affects the physical, mental, functional and social balance that patients used to have and, beyond the orthopedic injury, it reflects the aging process and its dire consequences. Some reports show that up to 50% of patients with hip fracture die within six months and many of those who survive do not recover their baseline independence and function. In recent decades the increase in life expectancy after 60 years of age has led to an exponential growth in hip fractures. This is why it is essential to determine the patient-related and environmental factors leading to the increased mortality rates seen in patients with hip fracture, to improve the survival and quality of life of older adults. The objective was to determine the association between hip fracture and mortality in patients over 65 years of age. MATERIAL AND METHODS: An observational, longitudinal, retrospective, descriptive, comparative case-control study was conducted. The clinical records of all patients over 65 years of age admitted to the Orthopedics Service, Hospital Regional <
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Fraturas do Quadril/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
The use of an on-line monitoring method based on photoelasticity techniques for the fabrication of micro-optical components by means of controlled laser heating is described. From this description it is possible to show in real time the mechanical stresses that form the microelement. A new parameter, stressed area, is introduced that quantifies the stresses of a microelement during its fabrication, facilitating a deeper understanding of the physical phenomena involved in the process as well as being a useful test of quality. It also permits the stress produced in the manufacturing process and the optical properties of the final microelement to be correlated. The results for several microlenses monitored with this technique are presented.
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The aim of this study was to describe findings of bone scintiscans and their clinical significance for patients infected with human immunodeficiency virus type 1 (HIV-1); 33 HIV-1-infected patients (22 men and 11 women) free of osteoarticular symptoms were included in the study. Plain bone roentgenograms, bone mineral contents (measured by dual-photon absorptiometry), and scintiscans (determined with 99mTc diphosphonate) were obtained for all subjects. Plain bone roentgenograms showed no abnormalities, and bone mineral contents were within the normal range for all patients. Radionuclide bone scans were unremarkable for eight patients (24%) and showed symmetrical abnormally increased uptake in the epiphyseal region of the appendicular skeleton in 25 (76%). Follow-up of the patients for > or = 1 year ruled out subsequent development of osteoarticular disorders. Generalized, symmetrical increased radionuclide uptake on bone scans is a common finding for HIV-1 infected patients free of osteoarticular symptoms. This finding is probably related to bone marrow hypercellularity and is of no clinical significance; therefore, other diagnostic procedures are not required in the workup of these patients.
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Osso e Ossos/diagnóstico por imagem , Infecções por HIV/diagnóstico por imagem , HIV-1 , Adolescente , Adulto , Densidade Óssea , Doenças Ósseas/complicações , Doenças Ósseas/diagnóstico , Difosfonatos , Feminino , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Humanos , Artropatias/complicações , Artropatias/diagnóstico , Masculino , Radiografia , Cintilografia , Compostos de TecnécioRESUMO
The aim of this study was to identify and describe possible alterations of bone histomorphometry in patients with human immunodeficiency virus (HIV-1) infection and to assess the relation between these alterations and disease severity. Forty-four HIV-1-infected patients seen successively at our hospital were evaluated for the study. In an attempt to avoid confounding factors as far as possible, we excluded patients who fulfilled any of the following criteria: age less than 18 or greater than 40 years; recent history of extended bed rest; previous diagnosis of metabolic bone disease, renal insufficiency, or hepatic failure; clinical or echographic signs of liver cirrhosis; diabetes mellitus or previous diagnosis of other endocrine diseases; drug therapy that could act on bone metabolism; and/or moderate to severe nutritional alteration. Twenty-two patients (13 men, 9 women; age: 27.9 +/- 4.1 years, mean +/- standard deviation) were included in the study. Plasma and urine biochemistry and calcium-regulating hormones were determined. Bone mineral content was measured on vertebrae L2 to L4 and on the neck and intertrochanteric areas of the femur by dual-photon absorptiometry. A transiliac bone biopsy was performed after double-tetracycline labelling, with histomorphometric study of undecalcified bone. Serum osteocalcin was found to be lower in patients who, according to the Centers for Disease Control (CDC) classification, had greater disease severity, and showed a positive correlation with the number of CD4+ T lymphocytes. No alterations in bone densitometry were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Densidade Óssea/fisiologia , Remodelação Óssea/fisiologia , Infecções por HIV/fisiopatologia , HIV-1 , Absorciometria de Fóton , Adulto , Biomarcadores/sangue , Biomarcadores/urina , Análise Química do Sangue , Contagem de Linfócito CD4 , Feminino , Fêmur/fisiologia , Infecções por HIV/sangue , Infecções por HIV/urina , Humanos , Ílio/fisiologia , Vértebras Lombares/fisiologia , Masculino , Osteocalcina/sangueRESUMO
Sjögren's syndrome (SS) is a systemic, autoimmune exocrinopathy in which destructive, inflammatory-cell infiltration can affect any gland. Although chronic atrophic gastritis is the most common form of gastrointestinal involvement in SS, pernicious anemia develops in rare cases. We therefore report a patient with these three associated diseases.
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Anemia Perniciosa/etiologia , Gastrite Atrófica/etiologia , Síndrome de Sjogren/complicações , Idoso , Humanos , Masculino , Síndrome de Sjogren/diagnósticoAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , Adenosina Desaminase/líquido cefalorraquidiano , Toxoplasmose/líquido cefalorraquidiano , Adulto , Córtex Cerebral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Toxoplasmose/diagnóstico por imagem , Toxoplasmose/tratamento farmacológicoRESUMO
A survey was carried out of all urinary tract infections which developed bacteremia during an 18 month period. The number of episodes of bacteremia of urinary origin (BUO) detected in our institution during that period was 108. The urinary tract was the most common origin of the cases of community acquired (CA) bacteremia and the third in the hospital acquired (HA) cases. In both types, the most frequent organism was E. coli (69.6% and 40%, respectively). The most common underlying diseases were diabetes mellitus (25.7%) and neoplasia (20%); nephrourologic disorders of some type were present in 29.6% of cases. In 81% of HA episodes there were urinary catheters as risk factors. In the CA bacteremias, the gram-negative bacilli except Pseudomonas aeruginosa had a 100% sensitivity to aminoglycosides. Sensitivity to first generation cephalosporins was detected in 81% of the E. coli and in 100% of the Klebsiella spp strains. In HA cases, amikacin (100% of E. coli, Pseudomonas, Klebsiella and Proteus) and cefotaxime (except Pseudomonas) were the antibiotics to which the highest rates of sensitivity were found. Overall mortality rate of BUO was 16.6% (13.6% for CA and 21.5% for HA); in 6% and 5% of cases, respectively, death was directly associated with bacteremia.