Marta Ruiz-Mambrilla

Epidemiology of Acute Carbon Monoxide Poisoning in a Spanish Region

Background: In Spain, as in most of the world, the incidence of acute carbon monoxide poisoning is probably underestimated. Methods: During an eighteen-month period we studied, by means of a standardized data collection form, all the cases of acute carbon monoxide poisoning that were diagnosed in 2 university hospitals. Results: During the study, 154 patients were diagnosed with carbon monoxide poisoning. The mean age was 32.2 ± 15.5 years. The two principal exposure sites were the kitchen (43%) and bathroom (23%). The majority of the cases related to malfunction of the water heater (30%) and of the central heating (23%) and 68% occurred in the home. Improper combustion of butane (31%), propane (13%), and natural gas (12%) were most frequent. The most prevalent clinical manifestations were headache (94%), dizziness (56%), nausea (45%), loss of consciousness (38%), and weakness (34%). Five patients died. In 14.4%, symptoms suggested delayed neurological syndrome. The largest number of cases of poisoning occurred during the months of December and January. Conclusions: Compared with previous Spanish series or with the antecedent year, acute carbon monoxide poisoning has a high prevalence in our region. Two factors appear to be essential to the accurate diagnosis of acute carbon monoxide poisoning: 1) the ability of emergency room physicians to recognize the clinical symptoms of carbon monoxide poisoning and 2) access to a carbon monoxide-oximeter.

Risk of mortality and predisposing factors after osteoporotic hip fracture: a one-year follow-up study

Background and aims: To determine mortality and predisposing factors in patients with fracture of the proximal femur, one year after the initial fracture, in a tertiary hospital in Castile and Leon (Spain). Methods: Observational case-control study. Patients aged ≥65 years admitted to the orthopedic surgery department of the Rio Hortega Hospital, a tertiary care hospital with approximately 560 beds, due to non-traumatic hip fracture between September 2005 and November 2006, were included. An age-matched control group of 81 institutionalized patients with similar characteristics was recruited. A protocolized telephone interview and a review of hospital medical records was made at 12 months followup. Results: Of the 170 patients recruited, the final analysis was made in 139: 121 (87.1%) women and 18 (12.9%) men. The control group was formed of 81 patients: 64 (79%) women and 17 (21%) men. Mortality was 41.7% in the study group and 2.5% in controls (p; 0.001). Mortality was 31% in month 1, 24.1% between months 2 and 6 and 29.3% between months 6 and 12 (in 15.6% the date of death was unknown). Factors associated with mortality were: age >86 years (p; 0.024); prior cognitive deterioration (p; 0.011); prior locomotor disorder (p; 0.047); male gender (p; 0.017); heart disease (p; 0.042). Conclusions: Patients with hip fracture, had substantially higher mortality than comparable healthy people, and mortality was highest in the first six months after fracture. Age and prior comorbidities were associated with excess mortality.

Role of Bone Morphogenetic Protein 2 Polymorphisms in Bone Mineral Density after the Start of Treatment with Atorvastatin

One of the pleiotropic effects of statins is their capacity to increase bone formation. This is due to, among other things, they modify BMP-2 pathway. Several experimental studies have confirmed that statins have bone anabolic properties but the consequences in bone metabolism in the clinical practice are very variable. Our hypothesis is that the clinical variability in bone metabolism response could be attributed, among other causes, to genetic factors. Therefore, we analysed polymorphisms in BMP-2 gene (rs235768, rs1980499, rs2273073 and rs1005464) in order to evaluate the role of these variants in modulating bone metabolism response to statins treatment in patients with acute coronary syndrome. Our results showed that being a carrier of the variant allele T of BMP2 rs2273073 polymorphism was associated with an increased in the total hip BMD following atorvastatin therapy. This is the first report showing an association between a polymorphism in BMP-2 gene and bone changes in response to atorvastatin treatment. This report reinforces the hypothesis that genetic factors are crucial in the clinical variability of bone metabolism changes in response to statin treatment. This article is protected by copyright. All rights reserved.

The Effect of Genistein Supplementation on Vitamin D Levels and Bone Turnover Markers during the Summer in Healthy Postmenopausal Women: Role of Genotypes of Isoflavone Metabolism

Aims: The objective of this study was to determine whether vitamin D and genistein supplementation had an additive beneficial effect on levels of vitamin D and bone markers and whether this effect was mediated by genes regulating isoflavone metabolism. Materials and Methods: We carried out a prospective study in postmenopausal women randomized to calcium and vitamin D supplementation or calcium, vitamin D, and genistein supplementation. Vitamin D, parathyroid hormone (PTH), cross-linked C-telopeptide (CTX), and procollagen 1 N-terminal (P1NP) were determined by electrochemiluminescence. Three SNPs - rs2231142 (ABCG2), rs358231 (cytosolic β-glucosidase [CBG]), and rs2273697 (ABCC2) - were determined. Results: We included 102 women. The effects on bone remodeling were similar: rises in vitamin D were significantly associated with reductions in PTH, CTX, and P1NP. Pharmacogenomic analysis of the genotypes showed that, in AT heterozygotes of the CBG1368T>A polymorphism, CTX and P1NP were not reduced. Conclusion: Genistein added to calcium and vitamin D supplementation had no additional effect. The supplementation of individual AT heterozygotes of the CBG1368T>A polymorphism had no effect on markers of bone remodeling.