[Predictive factors of 2009 H1N1 virus infection in patients with influenza syndrome]

INTRODUCTION

Polymerase chain reaction (PCR) testing is one of the better techniques for viral detection in nasopharyngeal swabs. The objective of this study was to assess the percentage of positive swabs and to determine whether there were differences according to PCR positivity.

MATERIAL AND METHODS

A retrospective study of 362 patients with flu syndrome attended at the Emergency Department between July 15 and December 15, 2009, in whom PCR of nasopharyngeal swabs for the detection of H1N1 2009 influenza virus was performed. Those cases in which swab testing was adequately requested were identified, and patients were divided into two groups according to positive or negative results for H1N1 2009 influenza virus.

RESULTS

Nasopharyngeal swab was inadequately ordered in 87. In the remaining 275 patients, PCR was positive in 141. Patients with positive nasopharyngeal swabs were younger (mean [SD] age 36.1 [15] vs 42.3 [18] years, P= 0.002), had lower white blood cell, neutrophil and lymphocyte counts, lower serum concentrations of C-reactive protein (5.15 [5] vs 10.5[12] mg/dL, P= 0.036) and lower incidence of radiological infiltrates (20.5% vs 33%, P= 0.036). In the logistic regression analysis, age, serum C-reactive protein levels, and lymphocyte count were independently associated with a positive nasopharyngeal swab.

CONCLUSIONS

About 50% of patients with flu syndrome had positive nasopharyngeal swabs for H1N1 2009 influenza virus. Age, C-reactive protein, and lymphocyte count were independent predictors of positivity.

Diabetes team consultation: impact on length of stay of diabetic patients admitted to a short-stay unit

OBJECTIVE

To assess the impact of endocrinology team consultation on hospital stay and clinical outcomes of diabetic patients admitted with a primary non-diabetes-related diagnosis in a short stay unit (SSU).

METHODS

Patients admitted to the SSU between 2001 and 2005. Between 2001 and 2003 there was no endocrinology team consultation available and the management of hyperglycemia was handled by the SSU team alone. From 2003 until 2005 an endocrinology team was in charge of diabetes care. We compared in both periods: prevalence of diabetes, length of hospital stay, mortality, early readmissions and number of patients requiring conventional hospitalization.

RESULTS

In period 2001-2003, 1023 patients were admitted, among which 212 were diabetic (20.7%). Over the years 2003-2005, 892 patients were hospitalized, 223 were diabetic (25%). Clinical characteristics of diabetic patients from both periods were comparable, but glycaemia at admission was higher on the second period (217 mg/dl versus 198 mg/dl). The length of stay of diabetic patients in the second period decreased from 5.49 to 4.90 days. There were no significant differences in mortality (1.4% versus 0.4%) or in early re-admissions among the two periods.

CONCLUSIONS

The intervention of a diabetes team diminished the average length of stay of diabetic patients.

Effect of smoking and smoking cessation on bone mass, bone remodeling, vitamin D, PTH and sex hormones

OBJECTIVE

To assess the effect of smoking and smoking cessation on bone density, bone remodeling markers, sex hormones, and vitamin D-PTH axis in healthy young subjects.

MATERIALS AND METHODS

We studied 74 healthy people (31 men, 43 women; mean age 32.2 (7) years) divided into 52 never smokers and 22 smokers, 15 of which stopped smoking for one month.

RESULTS

Male smokers compared with never smokers showed lower BMD (0.971 (0.11) g/cm(2) vs. 1.069 (0.09) g/cm(2), P=0.042); higher plasma estrone levels (32.37 (10.13) pg/mL vs. 20.91 (5.46) pg/mL, P=0.001); and lower serum iPTH levels (16.2 (3.5) pg/mL vs. 28.8 (2.0) pg/mL, P=0.008). In women, BMD values were similar in smokers than in never smokers, but 25-hydroxyvitamin D levels were lower in smokers (31.9 (15.1) ng/mL vs. 16.8 (9.9) ng/mL, P=0.002). After adjusting by age and coffee consumption, female smokers had higher urinary-NTX levels than never smokers. After smoking cessation, statistically significant decreases of 25-hydroxyvitamin D and SHBG plasma levels were observed in men and women, respectively.

CONCLUSIONS

Tobacco increases bone resorption and affects bone mass by some alterations in sex hormone metabolism, but also importantly by alterations on the vitamin D-PTH axis.

Vitamin D treatment in myelodysplastic syndromes

Myelodysplastic syndromes (MDS) are a group of clonal disturbances with defective cellular differentiation. Vitamin D3 (VD) analogues can act on the differentiation and maturity of different cell lines. We studied the effects of VD on a series of patients with MDS in an open-design trial. Nineteen patients, 12 men and seven women, with MDS were included. Patients were 74.8 +/- 5.6 years (mean +/- SD), seven had refractory anaemia with ringed sideroblasts, five had refractory anaemia, one had refractory anaemia with excess of blasts and six had chronic myelomonocytic leukaemia. All the patients were in a low to intermediate risk group. Mean follow-up period was 26.21 months, range 9-75. Responders were defined as follows: granulocyte or platelet count increase by 50%, or haemoglobin increase of 1.5 g/dl or transfusion needs decrease by 50%. The first five patients received 266 microg of calcifediol three times a week and the other 14 received calcitriol (0.25-0.75 microg/d). Response was observed in 11 patients. In the calcifediol-treated group, one case responded, three were nonresponders, and one showed progression. In the calcitriol group, 10 were responders (two with major response), and four were non-responders. No correlation was observed between baseline levels of vitamin D metabolites and the presence of response. No hypercalcaemia was observed. Treatment with vitamin D3 metabolites could induce a long-standing response of the haematological disturbance in some low-intermediate risk MDS patients without inducing hypercalcaemia.

[Screening for bone disease risk with clinical factors in women after physiologic menopause]

BACKGROUND

Densitometric screening for osteoporosis in postmenopausal women has not been demonstrated cost-effective. We have tried to identify clinical factors for screening previous to densitometry avoiding unnecessary explorations.

PATIENTS AND METHODS

SETTING

outpatient clinics of a menopausal unit in a 450-bed general hospital. Cross-sectional study, in two steps, of two groups of 140 and 284 women attending for physiological menopause. A clinical questionnaire, physical data and lumbar densitometry (Hologic QDR 1000) were obtained classifying the cases as "normal" or "low bone mass" (osteopenia or osteoporosis) according with the WHO criteria. In the first group a logistic regression analysis was done to identify predictive factors for abnormal densitometry, then validated in the second group. Sensitivity, specificity, predictive values (PV) and classification ability of clinical factors were analyzed.

RESULTS

Four factors were independent predictors of abnormal densitometry: age > 51 (odds ratio [OR] = 6.64; 95% CI, 2.36-18.7); body weight < 70 kg (OR = 4.32; 95% CI, 1.71-10.09); years of fertility < 32 (OR = 3.77; 95% CI, 1.36-10.04), and number of live births > 2 (OR = 3.47; 95% CI, 1.27-9.53). Presence of one factor offers: sensitivity 91.9%; specificity 15%; positive PV 66.6%, and negative PV 50%, whereas the presence of two factors offers: sensitivity 62.7%; specificity 70%; positive PV 79.9%, and negative PV 50.3%. Clinical screening allows, when two factors are present, to avoid a 35.5% of densitometries and the false-negative cases represent 18%.

CONCLUSIONS

Detection of bone-risk clinical factors (abnormal densitometry) yields a screening, previous to densitometry, that avoids at least one third of explorations in women with physiological menopause, improving the efficiency of the test.

Piroxicam fast-dissolving dosage form vs diclofenac sodium in the treatment of acute renal colic: a double-blind controlled trial

OBJECTIVE

To assess the possible therapeutic effect of 40 mg sublingual piroxicam (fast-dissolving dosage form, FDDF) compared with intramuscular 75 mg diclofenac, as a reference drug, on acute renal colic in a randomized, double-blind controlled clinical trial.

PATIENTS AND METHODS

Eighty patients were assigned to one of two treatment groups; one received an intramuscular injection with 0.2 mL distilled water and two sublingual tablets of 20 mg piroxicam FDDF, and the other received an intramuscular injection with 75 mg diclofenac sodium and two sublingual tablets of placebo. Pain intensity was evaluated by the patient using a visual analogue scale and by the observers. Vital signs at baseline and 30 min after the administration of the study drugs were also recorded.

RESULTS

The overall efficacy of the treatment was 81%; nine patients in the piroxicam and six in the diclofenac group (no significant difference) required rescue treatment. Compared with baseline levels, the pain relief was significant (P < 0.001) at 30 min in both groups. Twenty-two patients in the piroxicam and 25 in the diclofenac group attained complete pain relief at 30 min, as evaluated by the observer (no significant difference). Both treatments were similarly effective in decreasing vital signs, mainly systolic blood pressure, heart and respiratory rates. However, when the percentage change was compared between the groups, piroxicam significantly decreased the respiratory rate (P < 0.03).

CONCLUSION

Piroxicam FDDF is as effective as parenteral diclofenac in emergency renal colic treatment. Furthermore, its ease of self-administration increases patient compliance and potential use in general practice.

Intrahepatic cholestasis without hepatitis induced by amoxycillin/clavulanic acid

Amoxycillin/clavulanic acid liver injury is very rare. We describe an exceptional case of intrahepatic cholestasis without hepatitis induced by amoxycillin/clavulanic acid. Recognition of this benign cholestatic syndrome as a side-effect may obviate unnecessary complementary and costly procedures.

[Efficiency of bone marrow aspirate for diagnosis of opportunistic infections in HIV infected patients]

AIDS is the first cause of opportunistic infections. The objective of the present study was the evaluation of the efficiency of bone marrow aspirate (BMA) for diagnosis of opportunistic infections in HIV infected patients with prolonged fever. Charts from 92 patients with BMA from 1992 to 1994 were reviewed. Diagnosis was achieved in 14.1% of cases. Diagnosis cannot be made by other methods in six leishmaniasis and in two disseminated tuberculosis. The sensibility was of 33.3% for mycobacterial infections, the sensibility of hemoculture was of 50%. The hemoglobin level was lower for patients with diagnostic BMA than for patients with not diagnostic BMA (77 g/l vs 97 g/l, p < 0.0004). The WBC counts was not different in both groups of patients, and platelets counts was greater in patients with BMA diagnostic (165 x 10(9)/l vs 102 x 10(9)/l, p < 0.001). In the patients with hemoglobin lower than 100 g/l the diagnostic efficiency was 18.6% (11 of 59 cases). The BMA was unprofitable in HIV infected patients with prolonged fever without hemocytopenias. Profitability increase in patients with hemoglobin lower than 100 g/l. The BMA in useful for leishmania identification. The hemoculture has greater sensitivity than BMA for the diagnosis of mycobacterial disseminated infection.

[Effects of Sjögren's syndrome on pulmonary function impairment in patients with rheumatoid arthritis]

The influence of Sjögren syndrome (SS) on pulmonary function impairment in rheumatoid arthritis (RA) patients has been few studied. The aim of this study was to analyse the pulmonary function impairment in RA patients, and to establish differences between patients associated or not to SS. Pulmonary function of 57 patients, non smokers and without another pulmonary disease, diagnosed of RA were studied. Fourteen (24.6%) were associated to SS, and 43 (75.4%) to RA without SS. Age and time of evolution of disease were similar. Eight patients with associated SS (57.2%), and in 20 (46.5%) without SS showed pulmonary function disorder. Airflow obstruction and DLCO diminution were the most common types of impairment, respectively. The comparison between the types of impairment and the mean values of FEVI, FVC, FEVI/FVC %, FEF 25-75 and DLCO were not statistical different. This results suggest a poor influence on pulmonary function impairment in RA patients with SS.

Idiopathic bilateral diaphragmatic paralysis: effectiveness of bilevel intermittent positive airway pressure

A 49-year-old woman presented with idiopathic bilateral diaphragmatic paralysis. The patient benefited from bilevel intermittent positive airway pressure-type assisted ventilation with rapid, excellent and long-lasting results. This case emphasizes the need for correct diagnosis and therapeutic management, particularly with a bilevel intermittent positive airway pressure-type home ventilation technique, in idiopathic bilateral diaphragmatic paralysis.

[The sequelae of osteoporotic femoral fracture in Barcelona]

BACKGROUND

The aim of the present was to study the long term sequelae of osteoporotic fracture of the femur in a general hospital of 300 beds in Barcelona, analyzing 1) mortality; 2) degree of functional capacity; 3) care requirements; 4) familial repercussion, and 5) psychic repercussion.

METHODS

Structured telephone interviews were carried out between 1990-1991 with the patients attended for osteoporotic fracture of the femur in our center from 1988-1989. Of a total of 145 patients, 12 died within 1 month. Among the remaining patients the interview was performed with 100 patients--25 of whom were males of 78 +/- 8 years of age and 75 females of 82 +/- 10 years of age. The degree of functional capacity was evaluated by the index of independence in daily activities (DA).

RESULTS

Mortality within one month was 8.3%; at one year 30% and at 2 years 38%. Factors associated with the highest mortality were: age of over 80 years (p less than 0.004), deterioration of post fracture functional capacity (p less than 0.0004) and pre-fracture dementia (p less than 0.01). Important deterioration in post fracture functional capacity was seen in 45% of the cases. Seventeen percent of the patients required transfer to a center for chronic care and 34% resided in a center for chronic care prior to the fracture. Familial repercussion was observed in 43% of the cases and post fracture psychologic repercussion was seen in 28%.

CONCLUSIONS

Osteoporotic fracture of the femur presents the following sequelae: mortality, intense deterioration of functional capacity and important health care requirements in addition to considerable familial and psychological repercussion.

[Carcinoembryonic antigen in pleural effusion. Adenocarcinoma versus mesothelioma]

One hundred and thirty six patients presenting pleural effusion and whose diagnosis was obtained by clinical, biochemical, bacteriological, cytological and histological methods have been studied and classified into seven groups: 20 transudates, 29 inflammatory, 25 tuberculosis, 25 non adenocarcinoid neoplasias, 24 adenocarcinomas, 10 mesotheliomas and 3 miscellaneous. Carcinoembryonic antigen was determined in all of them, evaluating as positives those values above 10 ng/ml, value which we consider discriminatory in our series and which agrees with the literature, finding positive values in 21 out of 24 adenocarcinomas and 3 out of 25 non adenocarcinomas. All benign pleural effusions and mesotheliomas had values lower than 10 ng/ml. The specificity to determine adenocarcinomas in neoplastic effusions was 91.48% and the sensibility was 87.5%. We consider that the CEA determination is useful to differentiate adenocarcinomas from other neoplasias and that a positive value rules out mesothelioma.