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OBJETIVO: Los inhibidores de la aromatasa (IA) se han asociado con una pérdida de masa ósea acelerada y un mayor riesgo de fracturas osteoporóticas. Con este trabajo se pretendió evaluar los factores de riesgo de fractura incidente en pacientes con cáncer de mama que reciben IA. MATERIAL Y MÉTODOS: Estudio prospectivo-observacional de cohorte de mujeres con cáncer de mama que inician tratamiento con IA (cohorte B-ABLE). Las pacientes realizaron tratamiento durante 5 años o bien 2 ó 3 años si habían recibido previamente tamoxifeno. Se les evaluó la salud ósea desde el inicio del tratamiento hasta un año después de finalizar dicho tratamiento mediante densitometría ósea, marcadores de remodelado óseo, niveles de vitamina D y una radiografía antero-posterior y otra lateral de columna. Se realizó el cálculo de riesgo de fractura mediante la herramienta FRAX® antes de iniciar IA. Se utilizaron modelos de Cox para calcular los ratios de riesgo (HR [IC 95%]) de fractura. RESULTADOS: Un total de 943 pacientes fueron incluidas en el estudio. El 5,4% sufrieron una fractura incidente, la mayoría durante el tratamiento con IA, aunque un 21,5% ocurrieron durante el primer año después de finalizar la terapia. La mayoría de las fracturas incidentes fueron vertebrales clínicas (29,4%) y de Colles (31,4%). El 86,3% de las pacientes tenían un diagnóstico de osteopenia u osteoporosis en el momento de la fractura y el 33% tenían los niveles de β-CTX (isómero β del telopéptido carboxiterminal del colágeno tipo I) por encima de la normalidad. Las pacientes diagnosticadas de osteoporosis o con riesgo de fractura al inicio del estudio fueron tratadas con antirresortivos óseos. No se encontraron diferencias significativas en el riesgo de fractura entre pacientes con y sin tratamiento antirresortivo: HR=1,75 [IC 95%: 0,88 a 3,46]. Tampoco se encontraron diferencias entre las pacientes que habían hecho tratamiento previo con tamoxifeno respecto a las que no (HR=1,00 [IC 95%: 0,39 a 2,56]). La herramienta FRAX® dio valores de media dentro del rango de riesgo intermedio, con 13 pacientes con valores de alto riesgo de fractura principal. CONCLUSIONES: El principal factor de riesgo detectado para fractura incidente en pacientes tratadas con IA es el diagnóstico de osteopenia u osteoporosis. El cálculo de la herramienta FRAX® y la determinación de los niveles de β-CTX son herramientas útiles para identificar a pacientes de alto riesgo

OBJETIVO:Aromatase inhibitors (AI) have been associated with an accelerated loss of bone mass and an increased risk ofosteoporosis fractures. This study assesses the risk factors for incident fracture in breast cancer patients receiving AI. MATERIAL AND METHODS:Prospective‐observational cohort study of women with breast cancer who begin treatment withAI (B‐ABLE cohort). Patients were treated for 5 years or 2 or 3 years if they had previously received tamoxifen. Bone healthwas assessed from the beginning of the treatment until one year post treatment by bone densitometry, bone remodelingmarkers, vitamin D levels and an anteroposterior and lateral spine radiography. The fracture risk calculation was performedusing the FRAX® tool before starting AI. Cox models were used to calculate the risk ratios (HR [95% CI]) of fracture. RESULTS: A total of 943 patients were included in the study.5.4% suffered an incident fracture, most during AI treatment,although 21.5% occurred during the first year after the end of therapy. Most of the incident fractures were clinical vertebral (29.4%) and Colles (31.4%).86.3% of the patients had a diagnosis of osteopenia or osteoporosis at the time of the fractureand 33% had the levels of β‐CTX (β isomer of the carboxyterminal telopeptide of type I collagen) above normal. Patients diagnosed with osteoporosis or at risk of fracture at the start of the study were treated with bone antiresorptives. No significant differences in fracture risk were found between patients with and without antiresorptive therapy: HR=1.75[95% CI: 0.88 to 3.46]. Nor were differences found among patients who had previously treated with tamoxifen comparedto those who did not (HR=1.00 [95% CI 0.39 to 2.56]). The FRAX®tool gave average values within the intermediate riskrange, with 13 patients with high risk of major fracture values. CONCLUSIONS:The main risk factor detected for incident fracture in patients treated with AI is the diagnosis of osteopeniaor osteoporosis. The calculation of the FRAX® tool and the determination of β‐CTX levels are useful tools to identifyhigh‐risk patients

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Objetivo: El Hospital del Mar de Barcelona cubre un área de influencia (AI) de 350.000habitantes. En 2006, el 15,7% de esta población eran inmigrantes. El objetivo de este estudio es describir la distribución por países y zonas geográficas de los pacientes diagnosticados de tuberculosis en urgencias. Adicionalmente, se muestra el país y zona geográfica de procedencia de los inmigrantes censados en nuestra AI. Método: Se incluyeron los inmigrantes diagnosticados de tuberculosis durante 2006 y2007. Los datos poblacionales se obtuvieron del padrón municipal. Para cada país y zona geográfica se evaluó el porcentaje que representaba respecto a la población inmigrante censada (PIC), y el porcentaje respecto al total de tuberculosis en inmigrantes diagnosticados en urgencias (PTU). Se calculó el índice PTU/PIC para evaluar los casos de tuberculosis ajustados según los datos poblacionales. Resultados: El número de inmigrantes censados en 2006 fue de 54.057. Las nacionalidades más frecuentes fueron la pakistaní (14,1%) y la ecuatoriana (10,1%) y las zonas geográficas fueron Latinoamérica (38,3%) y Europa Occidental (19,2%). Se diagnosticaron60 casos de tuberculosis en inmigrantes, y fueron más frecuentes los casos procedentes de Pakistán (26,7%), seguidos de Bolivia (15%), Europa del Este (11,7%) y África del Norte (8,3%). Las mayores puntuaciones PTU/PIC correspondieron a Bolivia, Pakistán, Europa del Este y Asia Central. Conclusiones: La mayoría de los nuevos casos de tuberculosis en inmigrantes visitados en urgencias corresponden a pacientes originarios de Pakistán y de Latinoamérica, pero el mayor índice PTU/PIC se observa en los procedentes de Bolivia y Europa del Este (AU)

Objectives: Hospital de Mar in Barcelona serves a population of 350 000 inhabitants. In 2006, 15.7% of this population consisted of immigrants to Spain. The aim of this study was to describe the distribution by country and geographic region of immigrant patients diagnosed with tuberculosis in the emergency department. Additionally, we show the countries and geographic regions of origin of all immigrants identified by the census as residing in the area the hospital serves. Methods: The study included immigrants diagnosed with tuberculosis in 2006 and 2007. Population data were obtained from municipal census records. By country and region of origin, we analyzed the number of immigrants with tuberculosis, calculating percentages of the overall immigrant population recorded in the census (PIPC) and of the total number of immigrants diagnosed with this disease in the emergency department (PTED). The ratio between the two percentages (PTED/PIPC) was calculated to create an index reflecting the number of tuberculosis cases adjusted for population data. Results: A total of 54 057 immigrants were identified in the 2006 census. The largest national groups were those from Pakistan (14.1%) and Ecuador (10.1%). The largest regional groups were those from Latin America (38.3%) and Western Europe (19.2%). Sixty cases of tuberculosis were diagnosed in immigrants. Most of these patients came from Pakistan(26.7%) and Bolivia (15%). Attending to geographic region, patients from Eastern Europe (11.7%) and those from North Africa (8.3%) were the most frequently diagnosed. The highest PTED/PIPC indexes corresponded to Bolivia, Pakistan, Eastern Europe, and Central Asia. Conclusions: Most new cases of tuberculosis in immigrants diagnosed in the emergency department were found in patients from Pakistan and Latin America, but the highest PTED/PIPC indices were those for Bolivia and Eastern Europe (AU)

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Bronchofibroscopy is a widely used exploration for the diagnosis of several pulmonary processes. However, its use in aged patients, these being considered a high risk group, is still a controversial issue. The aim of this study was to analyze the indications, diagnostic performance and complications of the bronchofibroscopy in the elderly and to determine if there are any differences with respect to the adult population. A retrospective case control study was conducted, taking as cases those patients with 70 or more years of age, and as controls, those patients with less than 70 years. The study period was 1 year, with 54 bronchofibroscopies performed in 49 patients from the study group and 149 in 145 patients from the control group. The indications were similar in both groups, except for the study of opportunistic infections, these being more frequent among the control group. Diagnostic performance and complications did not show any differences between both groups. Indications, performance and complications of bronchofibroscopy in aged patients are similar to those in the adult population. Hence, the age in itself should not be a limiting factor for the indication of this exploration.

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The study of bone mass in experimental animals usually requires invasive techniques. Dual energy X-ray absorptiometry (DEXA) may be an alternative as a non-invasive method (1). Bone mineral density (BMD) and bone mineral content (BMC) of 62 vertebrae of Sprague Dawley rats (SDr) measured by DEXA densitometry were compared with histomorphometric bone volume measurements, and a statistically significant correlation was found (r = 0.79 and 0.75, respectively, p < 0.001). In conclusion, DEXA is an accurate and feasible technique for the study of trabecular bone mass in SDr.

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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.

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Digoxin is a widely used drug. Previous studies suggest a high prevalence of inadequate use, subtherapeutic levels and high toxicity rates. The aim of the present study was to evaluation the use of digoxin in our area. 50 consecutive patients who attended our emergency service and who were receiving digoxin on a chronic basis were prospectively evaluated. There were 37 females and males, with age 78.1 +/- 8.6 years. We found that digoxin was not indicated in 12% of cases. Only 48% had digoxin plasma levels within the therapeutic range. When plasma levels were considered in association with clinical and electrocardiographic findings, 12% of patients were undertreated and 6% had digitalis toxicity. There was no relation between the digoxin plasma level and the dosage schedule, the ECG findings, the renal function, the use of other drugs or the anthropometric data. Emphasis is made on the need to individualize digoxin therapy and to measure plasma levels in particular cases.

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We report a case of a primary cerebral abscess due to Nocardia asteroides in a nonimmunocompromised patient with a particular clinical course. The first symptom (right subacute brachial palsy) and the lesion in a computed tomographic (CT) scan (left parietofrontal edema suggestive of brain tumor) disappeared after corticosteroid treatment and the patient was discharged with total recovery. After 2 months she complained of headache and visual disturbance. A new CT scan showed an annular lesion in the left occipital lobe. A cerebral biopsy was diagnosed of nocardia infection. The patient died 2 weeks after this biopsy. A postmortem study showed an occipital brain abscess but not structural abnormalities were seen in the left parietofrontal area. We believe that the first episode could be a local inflammatory response to cerebral implantation of nocardia which disappeared clinically in the CT scan and in the postmortem study after corticosteroid treatment. Then the nocardia could have displaced by the hematological route to the second and definitive cerebral lesion.

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