Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. / Actividad ortogeriátrica en un hospital general de Castilla-La Mancha.

AIM: To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD: Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS: The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION: This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS: Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.

Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis.

UNLABELLED: Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk. INTRODUCTION: The objectives of the study were to measure the persistence and compliance with bisphosphonates for the treatment of osteoporotic patients, and to estimate the influence of compliance on fracture risk. METHODS: A systematic review of bisphosphonate adherence in clinical practise provided new evidence to perform a meta-analysis of the means of bisphosphonate persistence and compliance, with a subsequent meta-analysis of fracture risk comparing poorly versus highly compliant patients. RESULTS: Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most of the patients were postmenopausal women treated with bisphosphonates. The 3.95% of the patients received hormone replacement therapy, but the rest received bisphosphonates. The meta-analysis of five articles totalling 236,540 patients, who were followed for 1 year, provided a pooled persistence mean of 184.09 days. The meta-analysis of five articles, totalling 234,737 patients, who were also followed for 1 year, provided a pooled medication possession ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063 patients, who were followed for varying periods of time between 1 and 2.5 years, provided a pooled 46% increased fracture risk in non-compliant patients versus compliant patients. The increased fracture risk was lower for non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%). CONCLUSIONS: Persistence and compliance are suboptimal for postmenopausal women undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of this low compliance is an increased risk of fracture, which is lower for non-vertebral than for clinical vertebral fractures.

Sífilis tardía: reporte de un caso / Tertiary syphilis: a case report

A 48 year-old male presented with a 6 month history of a dementia syndrome, memory deficit, impairment of judgement, and right sligth hemiplegia, and sexual promiscuity, ELISA for HIV was negative; the VDRL and FTA-abs for syphilis were positive (1/8 and 3 mas respectively); VDRL int the CSF was positive (1/8) making the diagnosis of neurological syphilis. In addition, significant NMR images are presented. The patient received penicilin I.V. with clinical, neurological and radiological improvement.