Integration of a vertebral fracture identification service into a fracture liaison service: a quality improvement project.

Integration of a vertebral fracture identification service into a Fracture Liaison Service is possible. Almost one-fifth of computerised tomography scans performed identified an individual with a fracture. This increase in workload needs to be considered by any FLS that wants to utilise such a service. INTRODUCTION: This service improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS). METHODS: The service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then added as an addendum to the original CT report and the hospital FLS informed. The FLS made recommendations based on an agreed algorithm. RESULTS: In total, 4461 patients with CT scans were retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49% had the fractures described on hospital radiology report. On average, 61 patients were identified each week with a median of two fractures. Thirty-six percent were identified by the FLS for further action and recommendations were made to either primary care or the community osteoporosis team within 3 months of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures; already known to a bone health specialist; in the terminal stages of any chronic illness; significant dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS. There was a significant increase in workload which needs to be considered by any future FLS planning to incorporate such a service into their clinical practice.

Effect of an elevated monounsaturated fat diet on pork carcass and meat quality traits and tissue fatty acid composition from York-crossed barrows and gilts.

Fifty-seven York-crossed barrows and gilts were fed either a grain and soy diet (CONTROL with 28% C18:1) or a similar diet enriched with oleic acid (HO with 43% C18:1, Greedy-Grass OLIVA®). There were no interactions between dietary treatment and gender and there were no differences in intramuscular and subcutaneous fatty acid composition between sexes (P>0.05). Similar primal cut yields, composition of major primal cuts, and carcass and meat quality characteristics were found for HO and CONTROL fed pigs. Apart from a few significant but small differences for some fatty acids, intramuscular fatty acid composition was similar for both dietary treatments. Subcutaneous fat from HO fed pigs had a 6.9% increase in total monounsaturated fatty acids and a 9.3% reduction in total polyunsaturated fatty acids (P<0.05) compared with CONTROL fed animals, without adversely affecting carcass quality and producing suitable hams for processing by the meat industry.

Carcass and meat quality characteristics and fatty acid composition of tissues from Pietrain-crossed barrows and gilts fed an elevated monounsaturated fat diet.

Fifty-one (Landrace *Large White) *Pietrain barrows and gilts were used to compare the effect of a diet rich in oleic acid (HO) by feeding a by-product of the olive industry (Greedy-Grass OLIVA(R): 1.4% growing, 3.8% finishing) or a grain and soy diet (CONTROL) on carcass characteristics, meat quality and fatty acid profile of intramuscular and subcutaneous fat. Gilts had leaner (P<0.05) carcasses with lower fat percentage in major primal cuts, and less (P<0.05) saturated fat compared with barrows with no interaction (P>0.05) between dietary treatment and gender. Source of dietary fat had no effect (P>0.05) on primal cut yields, composition of major primal cuts, or carcass and meat quality characteristics. Intramuscular fat from HO fed pigs had higher (P<0.05) percentage of saturated (SFA) and monounsaturated (MUFA) fatty acids, and lower (P<0.05) polyunsaturated fatty acids (PUFA) and n-6:n-3 ratio compared with CONTROL animals (37.4% vs. 36.8%, 44.7% vs. 40.1%, 17.9% vs. 23.2%, and 18.9 vs. 21.8 ratio, respectively). Subcutaneous fat from pigs fed HO had greater (P<0.05) MUFA percentage, lower (P<0.05) SFA and PUFA percentage, and lower (P<0.05) n-6:n-3 ratio than pigs fed CONTROL diet (51.4% vs. 48.0%, 30.5% vs. 32.9%, 18.1% vs. 20.1%, and 9.83 vs. 11.3 ratio, respectively). Intramuscular fat had higher proportion of SFA and lower of MUFA showing a higher degree of tissue saturation compared with subcutaneous fat. Feeding Greedy-Grass increased MUFA and decreased PUFA proportions in fat depots reducing the risk of production of carcasses that are soft and oily which result in lower technological and processing quality.

[Varicella outbreak in a village in Uruguay]. / Estudio de un brote de varicela en un pueblo del Uruguay.

UNLABELLED: A varicella outbreak occurred in a Uruguayan village that introduced the varicella vaccine in 1999 with currently high vaccination rates. AIM: To investigate the cause of the outbreak, vaccine effectiveness, and to describe the measures adopted. MATERIAL AND METHODS: Cases that occurred in the kindergarten and schools in the village were investigated. Vaccination cards were examined, history of chickenpox and clinical characteristic of the current episode were obtained and the outcome of the measures was evaluated. An estimate was made of the vaccine's effectiveness. RESULTS: 37 cases of varicella were reported, 14 occurring in previously vaccinated children, in a one total population of 313 children. The global effectiveness of the vaccine was 80%, and 100% for severe cases. A shift of cases towards older ages was demonstrated; vaccinated children had a trend of less fever and lower number of lesions. Immunization of healthy unvaccinated children, mainly adolescents stopped the outbreak. COMMENTS: The vaccine proved to be highly effectiveness. In an outbreak situation, immunization policies should consider "catch up" vaccination in non-immunized adolescents without a previous history of varicella.

Estudio de un brote de varicela en un pueblo del Uruguay / Varicella outbreak in a village in Uruguay

A varicella outbreak occurred in a Uruguayan village that introduced the varicella vaccine in 1999 with currently high vaccination rates. Aim: To investigate the cause of the outbreak, vaccine effectiveness, and to describe the measures adopted. Material and Methods: Cases that occurred in the kindergarten and schools in the village were investigated. Vaccination cards were examined, history of chickenpox and clinical characteristic of the current episode were obtained and the outcome of the measures was evaluated. An estimate was made of the vaccine's effectiveness. Results: 37 cases of varicella were reported, 14 occurring in previously vaccinated children, in a one total population of 313 children. The global effectiveness of the vaccine was 80 percent, and 100 percent for severe cases. A shift of cases towards older ages was demonstrated; vaccinated children had a trend of less fever and lower number of lesions. Immunization of healthy unvaccinated children, mainly adolescents stopped the outbreak. Comments: The vaccine proved to be highly effectiveness. In an outbreak situation, immunization policies should consider "catch up" vaccination in non-immunized adolescents without a previous history of varicella.

Un brote de varicela acaeció en un pueblo uruguayo que había introducido la vacunación anti-varicela en 1999 y tenía altas coberturas de vacunación. Objetivo: Investigar las causas del brote, la efectividad de la vacunación y evaluar las medidas adoptadas. Material y Métodos: Se investigó los casos ocurridos enjardines de infantes y colegios. Se revisó el carné de vacunación de cada niño además de averiguar por historia previa de varicela, las características clínicas de los casos y el resultado de las medidas adoptadas. Se hizo una estimación de la efectividad de la vacuna. Resultados: Se presentaron 37 casos de varicela, 14 de los cuales habían recibido la vacuna, en una población total de 313 niños. La efectividad global de la vacuna fue de 80 por ciento, y de 100 por ciento para los casos graves. Se constató un desplazamiento de la enfermedad hacia edades mayores; además, los casos en vacunados tuvieron una tendencia a presentar menos fiebre y un número menor de lesiones. La vacunación de aquellos que no habían tenido la varicela y no estaban vacunados antes, detuvo el brote epidémico. Comentarios: Se demostró la efectividad de la vacuna. La política de vacunación debiera evaluar si es necesario proceder a la vacunación "de rescate" en adolescentes no vacunados y que no exhiben el antecedente de haber padecido la varicela.

Enfermedad de Marchiafava-Bignami en un paciente no alcohólico / Marchiafava-Bignami disease in a non-alcoholic patient

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[Aetiological diagnosis of cerebral infarction in a county hospital]. / Diagnóstico etiológico del infarto cerebral en el hospital comarcal.

INTRODUCTION: Cerebral infarction (CI) can be classified aetiologically in several different ways using explicit diagnostic criteria. However, the extent to which these diagnostic criteria are actually implemented in clinical practice is unknown. Aims. The aim of this study was to analyse the management and use of diagnostic tests in the aetiological diagnosis of CI in two county hospitals and to compare this with the most common recommendations. We also sought to analyse the clinical and demographic variables that may help to explain why these guidelines are not followed. PATIENTS AND METHODS: We reviewed the discharge abstracts of 307 cases of CI attended in two county hospitals between 1999 and 2000 and we analysed the clinical data, diagnostic tests and the final diagnosis. The diagnoses were reorganised using the TOAST, Laussane, NINDS and SEN 98 classifications and we analysed the frequency with which the diagnostic tests were employed in each aetiological subtype. RESULTS: Average age: 71.3 years; 59.3% were males. CAT scans were performed in 97.1% of cases, neurosonology was used in 40.1% and echocardiography was performed in 8.5%. The aetiological diagnosis was: atherothrombotic 22.4%, cardioembolic 10.7%, lacunar 26%, unusual causes 0.3% and unknown causes 1.6%. In 37.4% of cases the diagnosis was given as unspecified CI. On reclassifying the diagnoses according to SEN 98 criteria, we obtained the following: atherothrombotic 19.5%, cardioembolic 2.8%, lacunar 13.7% and of unknown origin 63.5%. 0.6% of the cases were unclassifiable. Factors that exerted an influence on the fact that diagnostic tests were less frequently carried out included age, level of awareness and mortality. The most frequent cause of incomplete studies was the absence of carotid Doppler. CONCLUSIONS: The guidelines for aetiological diagnosis of CI are not often followed. Systematic performance of a neurosonological study would improve aetiological diagnosis of CI.

Diagnóstico etiológico del infarto cerebral en el hospital comarcal / Aetiological diagnosis of cerebral infarction in a county hospital

Introducción. Existen diversas clasificaciones etiológicas del infarto cerebral (IC) con criterios diagnósticos explícitos, pero se desconoce el grado de implantación de estos criterios diagnósticos en la práctica clínica. Objetivos. Analizar el manejo y uso de las pruebas diagnósticas en el diagnóstico etiológico del IC en dos hospitales comarcales y compararlo con las recomendaciones más utilizadas. Analizar las variables clínicas y demográficas que influyen en la no adhesión a estas recomendaciones. Pacientes y métodos. Revisamos los informes de alta de 307 casos de IC atendidos en dos hospitales comarcales entre los años 1999 y 2000 y analizamos los datos clínicos, pruebas diagnósticas y el diagnóstico emitido. Reorganizamos los diagnósticos con la utilización de las clasificaciones TOAST, Laussane, NINDS y SEN-98. Analizamos la frecuencia de utilización de las pruebas diagnósticas en cada subtipo etiológico. Resultados. Edad media: 71,3 años; 59,3 por ciento fueron varones. Se realizó TAC en el 97,1 por ciento de casos, neurosonología en 40,1 por ciento y ecocardiografía en 8,5 por ciento. El diagnóstico etiológico fue: aterotrombótico, 22,4 por ciento; cardioembólico, 10,7 por ciento; lacunar, 26 por ciento; causa inusual, 0,3 por ciento; y causa desconocida, 1,6 por ciento. En el 37,4 por ciento de casos el diagnóstico fue IC no especificado. Al reclasificar los diagnósticos según los criterios SEN-98 obtuvimos: aterotrombótico; 19,5 por ciento; cardioembólico, 2,8 por ciento; lacunar, 13,7 por ciento; y causa desconocida, 63,5 por ciento. El 0,6 por ciento fueron inclasificables. La edad, nivel de conciencia y mortalidad influyeron en la menor realización de pruebas diagnósticas. La causa más frecuente de `estudios incompletos' fue la ausencia de doppler carotídeo. Conclusiones. La adhesión a las recomendaciones para el diagnóstico etiológico del IC es baja. La realización sistemática de estudio neurosonológico mejoraría el diagnóstico etiológico del IC (AU)

Introduction. Cerebral infarction (CI) can be classified aetiologically in several different ways using explicit diagnostic criteria. However, the extent to which these diagnostic criteria are actually implemented in clinical practice is unknown. Aims. The aim of this study was to analyse the management and use of diagnostic tests in the aetiological diagnosis of CI in two county hospitals and to compare this with the most common recommendations. We also sought to analyse the clinical and demographic variables that may help to explain why these guidelines are not followed. Patients and methods. We reviewed the discharge abstracts of 307 cases of CI attended in two county hospitals between 1999 and 2000 and we analysed the clinical data, diagnostic tests and the final diagnosis. The diagnoses were reorganised using the TOAST, Laussane, NINDS and SEN-98 classifications and we analysed the frequency with which the diagnostic tests were employed in each aetiological subtype. Results. Average age: 71.3 years; 59.3% were males. CAT scans were performed in 97.1% of cases, neurosonology was used in 40.1% and echocardiography was performed in 8.5%. The aetiological diagnosis was: atherothrombotic 22.4%, cardioembolic 10.7%, lacunar 26%, unusual causes 0.3% and unknown causes 1.6%. In 37.4% of cases the diagnosis was given as unspecified CI. On reclassifying the diagnoses according to SEN-98 criteria, we obtained the following: atherothrombotic 19.5%, cardioembolic 2.8%, lacunar 13.7% and of unknown origin 63.5%. 0.6% of the cases were unclassifiable. Factors that exerted an influence on the fact that diagnostic tests were less frequently carried out included age, level of awareness and mortality. The most frequent cause of ‘incomplete studies’ was the absence of carotid Doppler. Conclusions. The guidelines for aetiological diagnosis of CI are not often followed. Systematic performance of a neurosonological study would improve aetiological diagnosis of CI (AU)

[Emergency CAT in stroke-why?]. / TAC urgente en el ictus: por qu ?

INTRODUCTION: A stroke is considered to be a neurological emergency, and it is recommended that an immediate CAT scan should be done in all patients. However, its usefulness may be controversial in the early stages. OBJECTIVE: To show the diagnostic usefulness of early CAT scans following strokes. PATIENTS AND METHODS: We made a retrospective study of a random sample of the requests for cranial CAT scans in suspected cerebrovascular disease between October 1998 and April 2000. We analyzed the diagnostic and therapeutic variations before and after CAT scans (pre CAT and post CAT moments). RESULTS: We selected 210 cases. Average age: 72 10.4 (57% males). There was no difference in CAT findings (normal or vascular) related to the day it was done. Pre CAT diagnosis: non specific, 39.3%; intracranial haemorrhage (ICH), 17%. Post CAT diagnosis: the commonest was thrombotic infarct (23.7%), followed by non vascular , 20%. Pre CAT treatment: no treatment 47.9%; antiaggregant 30.4%; low molecular weight heparin 7.4%. Post CAT treatment: no treatment 17%, 21.7% of the patients with ICH received antiaggregants or anticoagulants prior to cranial CAT. Hemiplegia was more often associated with a vascular CAT scan whilst isolated dysarthria was with a normal CAT scan. Nineteen patients died and all of these had vascular CAT scans. The patients with vascular CAT scans were more often admitted to hospital. CONCLUSIONS: The findings of cranial CAT scans during the acute stage of strokes are unpredictable. Early CAT scans in stroke patients permits improved diagnosis and treatment of patients, avoids serious errors of treatment and affects the outcome.

High-Yielding Enantioselective Synthesis of the Macrolactam Aglycon of Sch 38516 from Two Units of (2R)-2-Ethyl-4-penten-1-ol.

The same precursor-namely, (2R)-2-ethyl-4-penten-1-ol-was used to obtain fragments C9-C13 and C1-C8 of 1, the aglycon of Sch 38516 (which is active against Candida sp.) and fluvirucin B(1) (which is active against influenza A virus). The key steps of the synthesis were the aldol-like reaction between the two fragments and the macrolactamization of a 13-azidotridecanoic acid derivative (see scheme). MOM=methoxymethyl, Py=2-pyridyl.

Three-year prospective study of intestinal pathogens in Madrid, Spain.

During the period July 1980 through June 1983, in a General Hospital in Madrid, the following organisms were detected from 6,970 patients with gastroenteritis: 710 Salmonella spp. 506 Campylobacter jejuni, 379 Shigella spp., 12 Yersinia enterocolitica, 1,466 rotavirus, 134 Giardia lamblia, and 4 Entamoeba histolytica. Chloramphenicol showed good activity against most tested strains of Salmonella spp., Shigella spp., and C. jejuni. The incidence of Salmonella spp. and Shigella spp. was very marked in the hot dry months of the year, rotavirus predominated during the cold months, and no seasonal variations of importance were seen for C. jejuni and G. lamblia.