Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales / Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes

Objetivos Evaluar la frecuencia de las admisiones en los servicios de urgencias (ASU) por ambulatory care sensitive conditions (ACSC) y no-ACSC de personas que viven en residencias; describir y comparar sus características, y analizar los costes asociados. Método Este estudio multicéntrico, retrospectivo y observacional evaluó 2.444ASU de personas ≥65 años que viven en residencias en 5 servicios de urgencias de Cataluña por ACSC y no-ACSC, en 2017. Se recogieron variables sociodemográficas, estado funcional y cognitivo, e información sobre diagnóstico y hospitalización. Se evaluaron los costes relacionados con ACSC-ASU y se efectuó un análisis de sensibilidad utilizando diferentes supuestos de disminución de ingresos por ACSC. Resultados La media de edad de la muestra del estudio fue de 85,9 años (desviación estándar: 7,2 años). La frecuencia de ACSC-ASU y no-ACSC-ASU fue del 56,6 y el 43,4%, respectivamente. El 56,6 y el 78% presentaban dependencia severa y deterioro cognitivo, respectivamente, sin observarse diferencias entre los 2 grupos. Las 3 ACSC más frecuentes fueron caídas/traumatismos (13,8%), enfermedad pulmonar obstructiva crónica/asma (11,4%) e infección urinaria (7,4%). El coste medio por ACSC-ASU fue de 1.408,24€. Suponiendo una reducción del 60% de las ACSC-ASU, el ahorro de costes estimado sería de 1,2 millones de euros. Conclusiones Las admisiones en urgencias por ACSC procedentes de entornos residenciales suponen un impacto significativo tanto en la frecuencia como en los costes. La disminución de estas enfermedades mediante la aplicación de intervenciones específicas podría redirigir los costes evitados hacia la mejora del apoyo asistencial en los entornos residenciales (AU)

Objectives To assess the frequency of emergency department admissions (EDAs) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalization process and the associated costs. Method This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥65 years old living in care homes in five emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalization were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC Results A total of 2444 ED admissions were analyzed. The patients’ mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was €1408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be €1.2 million. Conclusions Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs toward improving care support in residential settings (AU)

Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes.

OBJECTIVES: To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalisation process and the associated costs. METHOD: This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥ 65 years old living in care homes in 5 emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalisation were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC. RESULTS: A total of 2444 ED admissions were analysed. The patients' mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was є1,408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be є1.2 million. CONCLUSIONS: Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs towards improving care support in residential settings.

Cribado mediante angiogammagrafía previo a la realización de gammagrafía con leucocitos 99mTc-HMPAO en el diagnóstico de infección de prótesis articulares / Screening with angiographic images prior to 99mTc-HMPAO labelled leukocyte scintigraphy in the diagnosis of periprosthetic infection

Objetivo. Analizar la utilidad de la fase angiogammagráfica de la gammagrafía ósea en 3 fases como posible método de cribado en el diagnóstico de infección de prótesis de cadera y de rodilla, previa a la realización de la gammagrafía con leucocitos marcados. Material y métodos. Se analizaron prospectivamente 120 pacientes (70 mujeres y 50 hombres) con edad media de 71 ± 11 años y sospecha clínica de infección de prótesis de cadera (n = 63) o rodilla (n = 57), a los que se realizó gammagrafía ósea en 3 fases (angiogammagrafía, fase vascular y fase ósea) y gammagrafía con leucocitos marcados con 99mTc-HMPAO. El diagnóstico definitivo se realizó mediante estudio microbiológico o seguimiento clínico mínimo de 12 meses. Resultados. Se estableció el diagnóstico de infección de la prótesis articular en 18/120 pacientes: 10 pacientes con prótesis de cadera y 8 pacientes con prótesis de rodilla. La angiogammagrafía fue positiva en 15/18 pacientes infectados y en 21/102 pacientes no infectados, mostrando una sensibilidad del 83%, una especificidad del 79% y un valor predictivo negativo del 97%. La gammagrafía con leucocitos marcados mostró una sensibilidad y una especificidad del 72 y del 95%, respectivamente. Si se realizara la gammagrafía con leucocitos marcados exclusivamente a los pacientes con angiogammagrafía positiva, se reduciría un 70% de gammagrafías con leucocitos practicadas. No hubo ningún caso de infección con gammagrafía con leucocitos marcados positiva y angiogammagrafía negativa. Conclusiones. La angiogammagrafía es una buena técnica de cribado de infección de prótesis articulares de cadera y rodilla, disminuyendo significativamente el número de gammagrafías con leucocitos marcados, sin afectar la sensibilidad de la técnica (AU)

Aim. To evaluate the impact of the angioscintigrapy of the three phase bone scan as screening method to rule out infection of the hip and knee prosthesis prior to performing the 99mTc-HMPAO leukocyte scintigraphy. Material and methods. A total of 120 (70 women, 50 men; mean age 71 ± 11 years) with clinical suspicion of hip (n = 63) or knee (n = 57) infection of the prosthesis and clinical suspicion of infection were evaluated prospectively. All patients underwent three-phase bone scan (angioscintigraphy, vascular and bone phase) and 99mTc-HMPAO-labelled white blood cell scintigraphy. Final diagnosis of infection was made by microbiological documentation or clinical follow-up for at least 12 months. Results. Eighteen out of 120 patients were diagnosed of infection of hip prosthesis (n = 10) or knee prosthesis (n = 8). The angioscintigraphy was positive in 15/18 infected cases and in 21/102 of the non-infected cases with a sensitivity of 83%, specificity of 79% and negative predictive value of 97%. Sensitivity and specificity of 99mTc-HMPAO leukocyte scintigraphy were 72% and 95%, respectively. If the leukocyte labeled scintigraphies had been used exclusively for patients with positive angioscintigraphy, this would have saved up to 70% of the 99mTc-HMPAO leukocyte scintigraphies performed. There were no cases of infection with positive labeled leukocyte scintigraphy and negative angioscintigraphy. Conclusion. Angioscintigraphy (blood flow phase of bone scan) is a useful technique for screening for hip and knee joint prosthesis infection, significantly reducing the need for 99mTc-HMPAO leukocyte scintigraphy without affecting the sensitivity of the technique (AU)

[Screening with angiographic images prior to (99m)Tc-HMPAO labelled leukocyte scintigraphy in the diagnosis of periprosthetic infection]. / Cribado mediante angiogammagrafía previo a la realización de gammagrafía con leucocitos (99m)Tc-HMPAO en el diagnóstico de infección de prótesis articulares.

AIM: To evaluate the impact of the angioscintigrapy of the three phase bone scan as screening method to rule out infection of the hip and knee prosthesis prior to performing the (99m)Tc-HMPAO leukocyte scintigraphy. MATERIAL AND METHODS: A total of 120 (70 women, 50 men; mean age 71±11years) with clinical suspicion of hip (n=63) or knee (n=57) infection of the prosthesis and clinical suspicion of infection were evaluated prospectively. All patients underwent three-phase bone scan (angioscintigraphy, vascular and bone phase) and (99m)Tc-HMPAO-labelled white blood cell scintigraphy. Final diagnosis of infection was made by microbiological documentation or clinical follow-up for at least 12months. RESULTS: Eighteen out of 120 patients were diagnosed of infection of hip prosthesis (n=10) or knee prosthesis (n=8). The angioscintigraphy was positive in 15/18 infected cases and in 21/102 of the non-infected cases with a sensitivity of 83%, specificity of 79% and negative predictive value of 97%. Sensitivity and specificity of (99m)Tc-HMPAO leukocyte scintigraphy were 72% and 95%, respectively. If the leukocyte labeled scintigraphies had been used exclusively for patients with positive angioscintigraphy, this would have saved up to 70% of the (99m)Tc-HMPAO leukocyte scintigraphies performed. There were no cases of infection with positive labeled leukocyte scintigraphy and negative angioscintigraphy. CONCLUSION: Angioscintigraphy (blood flow phase of bone scan) is a useful technique for screening for hip and knee joint prosthesis infection, significantly reducing the need for (99m)Tc-HMPAO leukocyte scintigraphy without affecting the sensitivity of the technique.

Elimination of persistent organic pollutants from fish oil with solid adsorbents.

Fish oils are one of the main sources of ω-3 fatty acids in animal and human diet. However, they can contain high concentrations of persistent organic pollutants due to their lipophilic properties. The aim of this study is the reduction of persistent organic pollutants in fish oil using silicon-based and carbon-based solid adsorbents. A wide screening study with different commercially available adsorbents was carried out, in order to determine their capacity of pollutant removal from fish oil. Moreover, adsorption conditions were evaluated and optimized with using an experimental design and adjustment of the experimental results to response surfaces, obtaining removals rates of more than 99% of PCDD/Fs, 81% of dioxin-like PCBs, 70% of HCB, 41% of DDTs, 16% of marker PCBs and 10% of PBDEs. Finally, fish oil fatty acids were analyzed before and after the treatment with solid adsorbents, confirming that it did not affect its nutritive properties.

Caso de musculoesquelético presentado en la Sesión General de Lectura de Casos del XXX Congreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

No disponible

Fracture of a ceramic liner in a total hip arthroplasty with a sandwich cup.

Alumina ceramic-on-ceramic total hip arthroplasty (THA) has been widely used due to its advantages such as low wear, scratch resistance, wettable surface and relatively low biological reactivity of the wear particles. Nevertheless, this material in THA still persists to be one of the major concerns about the risk of fracture, due to its brittleness. Many authors have reported a fracture of the ceramic head but few reported a fracture of the ceramic acetabular insert. In order to reduce the rigidity of the ceramic-on-ceramic coupling and prevent an impingement between the rim of the ceramic liner and the metal neck of the femoral stem, a modular acetabular component with a sandwich insertion (alumina/polyethylene/titanium) was proposed. We report the fracture of the ceramic acetabular liner of such a ceramic sandwich cup due to a slightly retroverted position of the cup that causes an impingement between the femoral stem and the rim of the insert. The fracture occurred 3 years after the operation without trauma. At revision the entire cup was replaced using a polyethylene liner without inner ceramic liner.

Pathological femur fracture secondary to radiation therapy for soft tissue sarcoma.

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described.

Pathological femur fracture secondary to radiation therapy for soft tissue sarcoma

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described (AU)

Psoas abscess associated with infected total hip arthroplasty: a case report.

Psoas abscess (PA) is an uncommon disease and its diagnosis is difficult. It can be primary or secondary. Primary abscesses are of unknown origin and are presumably caused by haematogenous or lymphatic spread from a distant infectious focus. Secondary PA is caused by spreading from a contiguous infected structure, such as vertebrae (espondilodiscitis) or mesenteric abscesses (Crohns disease). PA infrequently has been associated with an infection of total hip arthroplasty (ITHA). The correct diagnosis in these cases is difficult due to the clinical similarities between PA and ITHA. Since connection between PA and ITHA is established through the acetabulum, we consider that computed tomography (CT) is the most accurate radiological test because of its efficacy in evaluating the bone structure, and the optimum therapeutic strategy is two-stage replacement surgery. We report one case of PA associated with ITHA and a review of the previous literature.

C1 to C9 volatile organic compound measurements in urban air.

Urban atmospheric samples were collected in A Coruna (NW Spain) and analysed for volatile organic compounds. One hundred and twenty one hour samples were collected in winter 2000. The ambient air was rich in benzene, toluene, ethyl-benzene and xylenes (BTEX) and especially toluene (mean: 23.6 microg m(-3), median: 14.66 microg m(-3)), but the presence of chlorinated compounds was also notable. High concentrations of 1,4-dichlorobenzene (mean: 11.4 microg m(-3), max: 90.4 microg m(-3)) were recorded. Multivariate analysis of VOC, trace gases (NO(x), NO(2), NO, SO(2) and O(3)) and meteorological variables (temperature, wind direction and speed, precipitation and radiation) was applied and correlations between VOC were also studied. Principal component analysis and correlation analysis confirm traffic as the main source of VOC in the area, although the importance of evaporative sources is also reflected. Three groups of samples were obtained by cluster analysis; these groups are formed depending on the content of aromatics and ozone and, in many cases, on the sampling hour.

Pilot study of treatment of biochemotherapy-refractory stage IV melanoma patients with autologous dendritic cells pulsed with a heterologous melanoma cell line lysate.

Eleven AJCC stage IV melanoma patients with progressive disease after treatment with biochemotherapy were treated with autologous dendritic cells pulsed with heterologous tumor cell lysates. The vaccine used mature DCs (CD1a+++, CD40++, CD80++, CD83+, and CD86+++) generated from peripheral blood monocytes in the presence of GM-CSF and IL-4. After 7 days, DCs were matured with a defined cocktail of cytokines (IL-1+IL-6+TNF-alpha+PGE2) and simultaneously pulsed with lysates of heterologous melanoma cell lines, for 2 days. A total of 4 x 10(6) DCs was injected monthly under ultrasound control in an inguinal lymph node of normal appearance. The study was closed when all patients died as a consequence of tumor progression. No sign of toxicity was observed during the study. One patient experienced a partial response lasting 5 months, and two patients showed a mixed response which lasted 3 months. The median survival of the whole group was 7.3 months (range 3-14 months). This vaccination program had specific antitumoral activity in highly pretreated and large tumor burden stage IV melanoma patients and was well tolerated. The clinical responses and the median survival of the group of patients, together with the low toxicity of our DC vaccine, suggest that this approach could be applied to earlier AJCC stage IV melanoma patients.

Vertebroplastia y cifoplastia / Vertebroplasty and kyphoplasty

No disponible

Hemoptisis masiva fatal por tuberculosis / Massive fatal hemoptysis due to tuberculosis

No disponible

Osteosarcoma en la enfermedad de Paget. Descripción de 6 casos / Osteosarcoma in Paget's disease. Report of six cases

Algunos pacientes con enfermedad ósea de Paget pueden desarrollar un osteosarcoma en la lesión pagética. Aunque se trata de una complicación infrecuente, el diagnóstico precoz de esta entidad es fundamental debido a su elevada mortalidad. Con el fin de analizar las características clínicas de estos pacientes y de valorar la utilidad de las pruebas de laboratorio en la sospecha diagnóstica de este proceso, se han revisado los pacientes con enfermedad ósea de Paget y osteosarcoma atendidos en nuestro centro en los últimos 12 años. Se describen 6 casos que corresponden a 3 varones y 3 mujeres, 5 de ellos con una enfermedad poliostótica, que desarrollaron dolor local intenso, en ocasiones asociado a sintomatología neurológica o a tumefacción de partes blandas. Tres pacientes seguían control por su enfermedad de Paget desde hacía más de 12 años, mientras que en 3 pacientes el diagnóstico del sarcoma óseo coincidió con el de la enfermedad de Paget. En ninguno de los pacientes de los que se disponía de seguimiento previo se observó un cambio significativo en las pruebas básicas de laboratorio (VSG, calcemia), ni en los valores de la fosfatasa alcalina, que alertaran al clínico de la posibilidad de una degeneración sarcomatosa. La sintomatología y las alteraciones radiológicas fueron las principales manifestaciones de este proceso (AU)

[Threatening hemoptysis. Results of treatment with arterial embolization]. / Hemoptisis amenazante. Resultados del tratamiento mediante embolización arterial.

OBJECTIVE: Retrospective analysis the immediate and long-term efficacy of embolization of bronchial and systemic arteries in the treatment of threatening or relapsing hemoptysis. MATERIALS AND METHODS: During the study period 122 arterial embolizations were performed in patients with hemoptysis over 100 ml in 24 hours, relapsing hemoptysis and/or presence of vital risk factors. Embolization was performed with polyvinyl alcohol particles, spongostan and metallic spirals. Seventy patients were included in the study and 47 were excluded as they came from other institutions. RESULTS: Angiographic changes were observed in 100% of patients. The immediate clinical success, defined as hemoptysis control, was obtained in the 70 patients. The mean follow-up time was 21.2 +/- 16.3 months. Relapsing hemoptysis occurred in 17.1% of patients (12 patients), of which 5.7% (4 cases) occurred in the first seven days and in 11.4% (8 patients) after 6 months. In five patients (7.1%) a new embolization was performed and 6 were operated after embolization (5 of them with bronchiectasis). The remarkable complications derived from the procedure included self-limited paraparesis of the lower limbs and severe chest pain. CONCLUSIONS: The embolization of bronchial arteries is an efficient technique for the treatment of threatening hemoptysis and relapses, is associated with a low morbidity rate, and the late relapse is relatively common among patiets with bronchiectasis.

Composition and chemical polymorphism of the essential oils from Piper lanceaefolium.

Essential oils obtained by hydrodistillation from leaves and spikes of Piper lanceaefolium H.B.K. of Costa Rica were analysed by GC-FID, GC-MS and 13C-NMR methods. Main constituents found in the oil from leaves were sesquiterpene hydrocarbons - especially beta-caryophyllene and germacrene D - and phenylpropanoids, of which elemicin and parsley apiol were the major ones. The volatile oil from spikes showed monoterpene hydrocarbons, namely alpha- and beta-pinene, and the same phenylpropanoids as in the oil from leaves as the major constituents. Results obtained in the analysis by GC-FID and GC-MS of the essential oils from individual plants of different geographic origin were submitted to chemometric cluster analysis and principal component analysis, showing the presence of three different types of oils (i) parsley apiol/elemicin, (ii) elemicin/parsley apiol/dill apiol, and (iii) parsley apiol/dill apiol.