Francisco Gómez

Fractura no vertebral por fragilidad en una cohorte de 5.201 mujeres de 65 años o más durante 3 años de seguimiento

Fundamento y objetivo: Las fracturas no vertebrales por traumatismo leve son una causa creciente de morbimortalidad en los ancianos. Nuestro objetivo ha sido determinar la incidencia de fracturas no vertebrales por traumatismo leve, en conjunto y en las principales localizaciones anatomicas, en una muestra de mujeres espanolas. Pacientes y metodo: Se incluyo a 5.201 mujeres de 65 anos o mas seleccionadas mediante un muestreo no probabilistico de casos consecutivos en las consultas de 58 centros de atencion primaria de Espana. El estudio fue de caracter prospectivo y tuvo 3 anos de duracion, con visitas periodicas cada 6 meses. Se recogieron todas las fracturas no vertebrales por fragilidad confirmadas por radiologia o por el informe quirurgico. Resultados: Se recogieron 363 fracturas no vertebrales en 311 mujeres (6,0%), tras una mediana de seguimiento de 3,01 anos y en un total de 14.999 mujeres/ano. La tasa de incidencia de cualquier fractura no vertebral fue de 2.420 por 100.000 mujeres/ano. Las tasas de incidencias de fracturas de cadera, antebrazo y humero fueron de 887, 360 y 333 casos por 100.000 mujeres/ano, respectivamente. Conclusiones: Las fracturas no vertebrales por traumatismo leve en mujeres de 65 anos o mas tienen una incidencia elevada en Espana, similar a la de otros paises occidentales.BACKGROUND AND OBJECTIVE Low-trauma non-spinal fractures are a growing source of morbidity and mortality in the elderly. We aimed to evaluate the overall incidence of low-trauma non-spinal fractures and of the main skeletal sites in a cohort of women from Spain. PATIENTS AND METHOD A total of 5,201 women, aged 65 or older, were enrolled in a 3-year cohort study by non-probabilistic sampling of consecutive cases in 58 primary care centers in Spain, with 6-month visits. All radiological or surgically confirmed low trauma non-spinal fractures were collected. RESULTS 311 women (6.0%) sustained a total of 363 fractures after a 3.01-year median follow-up, and 14,999 women-year. The incidence rate of overall non-spinal fractures was 2,420 cases per 100,000 women-year. The incidence rates of hip, forearm and humeral fractures were 887,369 and 333 cases/100,000 women-year respectively. CONCLUSIONS Low-trauma non-spinal fractures are highly incident in Spain in women aged 65 years or older, similar to other western countries.

Individualization of Theophylline Dosage in Adults with Bronchial Asthma

The influence of age on the disposition of theophylline was studied in 95 adult patients (nonsmokers) with bronchial asthma requiring oral theophylline therapy: 17 patients age ≥39 years, 50 patients age 40–59 years, and 28 patients < 60 years. A decrease was observed in total body clearance together with an increase in the elimination half-life of theophylline parallel to the advance in age of the patients. The apparent volume of distribution of theophylline was similar in the three groups of patients. According to the results obtained, recommendations are made regarding the dosage regimens of theophylline in elderly patients.

Hemodynamic and Inflammatory Markers of Sleep Apnea-Hypopnea Syndrome and Nocturnal Hypoxemia: Effects of Treatment With Nasal Continuous Positive Airway Pressure

OBJECTIVE In this study, we assessed factors associated with cardiovascular risk in patients with sleep apnea-hypopnea syndrome (SAHS) through analysis of plasma concentrations of N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity C-reactive protein (hsCRP). In addition, we analyzed the effect of nasal continuous positive airway pressure (nCPAP) on these markers. PATIENTS AND METHODS Forty-two patients with SAHS (mild to moderate in 15 cases and severe in 27) were compared with 14 individuals without SAHS. The participants were not receiving drug treatment and they did not have diabetes, hypertension, marked dyslipidemia, or cardiovascular disease, which was ruled out both clinically and by echocardiography and (99m)Tc-tetrofosmin scintigraphy at rest and during exercise. The effects of nCPAP in patients with severe SAHS were analyzed after 6 months of treatment. RESULTS Following adjustment for age, body mass index, and smoking habit, the mean concentrations of markers were not significantly higher in patients with severe SAHS than in those with mild-to-moderate SAHS or in control subjects. Nevertheless, in patients with SAHS the main factor influencing NTproBNP concentrations was the percentage of time with a nocturnal arterial oxygen saturation of less then 90% (r=0.37, P=.017). No variables predictive of hsCRP concentration were identified. The concentrations of the markers were reduced by nCPAP, but the differences were not statistically significant. CONCLUSIONS While nocturnal hypoxemia in SAHS is responsible for variations in the plasma concentration of NTproBNP (as a result of cardiovascular changes), SAHS appears not to be associated with the inflammatory marker hsCRP when patients with heart disease, cardiovascular risk factors, or those receiving pharmacologic treatment are excluded.