Oral health-related quality of life in Iranian patients with spinal cord injury: A case–control study

IntroductionThe study aimed to compare the oral health variables, general, and oral health-related quality of life (QoL), depression, and anxiety between spinal cord injury (SCI) patients and healthy controls and also to determine the key factors related to the oral health-related quality of life (OHRQoL) in the SCI patients.MethodsA total of 203 SCI patients and 203 healthy controls were enrolled. Patients and healthy adults were invited to attend a dental clinic to complete the study measures and undergo oral clinical examinations. OHRQoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14), and the general health-related quality of life (GHRQoL) was evaluated by SF-36. In SCI patients, depression and anxiety were recorded using the Hospital Anxiety and Depression Scale (HADS), while Functional Assessment Measure (FAM) was used to assess dependence and disability. All the subjects were examined for caries which was quantified using the decayed, missing, and filled Teeth (DMFT) index, gingival bleeding index (GI), plaque index, and periodontal status by community periodontal index (CPI).ResultsThe analysis of covariance (ANCOVA) revealed significant differences between the two groups in terms of oral health expressed in DMFT, oral hygiene, and periodontal status, controlled for age, gender, family income, and occupational status (p < 0.001). Using the hierarchical linear regression analyses, in the final model, which accounted for 18% of the total variance (F(126.7), p < 0.01), significant predictors of OHRQoL were irregular tooth brushing (β = 1.23; 95% CI = 1.06; 1.41), smoking (β = 0.82; 95% CI = 0.66; 0.97), dry mouth (β = 0.37; 95% CI = −0.65 to 0.10) functional and motor functioning (β = 0.32; 95% CI = −0.45 to 0.17), DMFT (β = 0.06; 95% CI = 0.02; 0.09), CPI (β = 0.22; 95% CI = 0.04; 0.04), physical component measure of GHRQoL (β = −0.275; 95% CI = −0.42 to 0.13), lesion level at the lumbar–sacral (β = −0.18; 95% CI = −0.29 to −0.06) and thoracic level (β = −0.09; 95% CI = −0.11 to −0.06).ConclusionSCI patients had poor oral hygiene practices, greater levels of plaque, gingival bleeding, and caries experience than the healthy controls. In addition, more number of SCI patients had periodontal pockets and dry mouth than the comparative group. SCI patients experienced more depression and anxiety, poor GHRQoL, and OHRQoL than the healthy control group. The factors that influenced OHRQoL in SCI patients were age, toothbrushing frequency, smoking, oral clinical status, depression, physical component of GHRQoL, and level of lesion.     

Association between family history of cancers and risk of prostate cancer

IntroductionFamily history of prostate cancer is an established risk factor for prostate cancer. However, the relationship between family history of cancers other than prostate cancer and prostate cancer risk is inconclusive. This study sought to examine the association between family history of cancers and prostate cancer.MethodsA case–control study was conducted in which cases and controls were randomly selected from a large urology clinic in Central Virginia. Cases were 600 histologically confirmed prostate cancer patients who were diagnosed between January 2000 and December 2005, and controls were 686 patients who visited the clinic during the same period and were diagnosed with urological illnesses other than cancers and prostate-related problems. Data on family history of cancers, lifestyle and demographic factors were collected through mail survey utilizing the method suggested by Dillman. Unconditional logistic regression analysis was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI) after adjustment for potential confounding factors including body mass index (BMI), alcohol intake, physical activity, smoking, diet, history of vasectomy and sexually transmitted disease (STD), age, race, marital history, education, and income. Multiple comparisons adjustments were made using the Bonferroni adjustment.ResultsMen with a family history of any cancer in first-degree relatives including parents (OR = 2.42, 95% CI = 1.53–3.84) and parents only (OR = 1.90, 95% CI = 1.23– 2.94) were at increased risk of developing prostate cancer. Significant increased risk was also observed with family history of prostate cancer in first-degree relatives (OR = 2.68, 95% CI = 1.53–4.69) and parents only (OR = 3.26, 95% CI = 1.71–6.24). Even after adjustments for multiple comparisons, the significance persisted both in first-degree relatives (OR = 2.68, 95% CI = 1.16–6.21) and parents alone (OR = 3.26, 95% CI = 1.24– 8.63).ConclusionThis study demonstrated an increased prostate cancer risk for men with a family history of any cancer or prostate cancer in first-degree relatives and parents alone. Health care providers need to be aware of the potential risk of family history of cancers on prostate cancer.     

The efficacy of dendritic cell vaccine for newly diagnosed glioblastoma: A meta-analysis of randomized controlled studies

IntroductionThe efficacy of dendritic cell vaccine to treat glioblastoma remained elusive and therefore we conducted a meta-analysis to explore the influence of dendritic cell vaccine on treatment efficacy of glioblastoma.MethodsPubMed, EMbase, Web of science, EBSCO and Cochrane library databases have been searched through October 2020, and we included randomized controlled trials (RCTs) assessing the efficacy of dendritic cell vaccine for glioblastoma.ResultsFour RCTs and 267 patients were included in the meta-analysis. Compared to control group for glioblastoma, dendritic cell vaccine demonstrated no obvious impact on overall survival (HR = 0.59; 95% CI = 0.34 to 1.04; P = 0.07), progression-free survival (PFS, HR = 0.72; 95% CI = 0.52 to 1.00; P = 0.05), nervous system disorders (OR = 0.61; 95% CI = 0.29 to 1.29; P = 0.20), or adverse events (OR = 1.44; 95% CI = 0.82 to 2.50; P = 0.20).ConclusionsDendritic cell vaccine may be not effective to treat glioblastoma.     

Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

BackgroundTranslation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia.AimTo evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities.Materials and MethodsFifteen patients (20 feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction.ResultsMean follow-up was 25 months (range 22–30). The IM angle improved from a median of 18.60 (range 13.4–26.20) preoperatively to 9.70 (range 8.0–13.70) postoperatively (8.9; 95% CI = 7.6–10.3; p < 0.001). The HV angle improved from a mean of 43.2 (range 27.4–68.2) preoperatively to 13.6 (range 3.0–37.4) postoperatively (29.6; 95% CI = 26.1–33.2; p < 0.001).The median AOFAS score improved from 29.2 (range 14–60) preoperatively to 82.2 (range 55–100) postoperatively (53.0; 95% CI = 48.0–58.5; p < 0.001). All patients rated their satisfaction as either satisfied or very satisfied. None had symptoms of transfer metatarsalgia at final follow-up. All osteotomies united.ConclusionsShortening Scarf osteotomy is a viable option for treating severe hallux valgus deformities with no transfer metatarsalgia.     

BsmI,TaqI, ApaI and FokI polymorphisms in the vitamin D receptor (VDR) gene and risk of fracture in Caucasians: A meta-analysis

ContextVitamin D receptor (VDR) gene polymorphisms have been strongly associated with bone mineral density in some studies. However, in a recent meta-analysis, no relationship of the VDR BsmI or TaqI polymorphism and fracture risk was found in the meta-analysis of published data.Objective and designOur meta-analysis studied whether a relationship exists between BsmI, TaqI, ApaI and FokI polymorphisms in the VDR gene and risk of fracture.Data sourcesRelevant studies were identified from the following electronic databases: MEDLINE, EMBASE and Current Contents before January 2010.Data synthesisThis meta-analysis included 17 studies with a total of 21 eligible comparisons, which included 2112 fracture cases and 4521 controls. All of these studies reported on Caucasians. The combined results based on all studies showed that fracture cases had a significantly lower frequency of bb genotype of BsmI [odds ratio (OR) = 0.87, 95% confidence interval (CI) = 0.76, 0.98]. When stratifying by fracture type, we found that (1) hip fracture cases had a significantly lower frequency of bb genotype of BsmI (OR = 0.82, 95% CI = 0.70, 0.97); (2) hip fracture cases had a significantly lower frequency of Tt genotype of TaqI (OR = 0.65, 95% CI = 0.43, 0.97); (3) hip fracture cases had a significantly higher frequency of tt genotype of TaqI (OR = 1.74, 95% CI = 1.05, 2.91); (4) vertebral fracture cases had a significantly higher frequency of Aa genotype of ApaI (OR = 1.63, 95% CI = 1.03, 2.59). No significant difference was found in any genotype of FokI.ConclusionOur meta-analysis suggests that there is a modest but statistically significant association between the BsmI bb genotypes and fracture.     

Outcomes of partial and total calcanectomies for the treatment of diabetic heel ulcers complicated with osteomyelitis. A systematic review and meta-analysis

BackgroundInfected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. However, there is a lack of pooled quantitative evidence on their efficacy and complications.ObjectivesThe present systematic review and meta-analysis was conducted to determine the primary outcome of healing rates following partial (PC) and total calcanectomies (TC) in treating calcaneal osteomyelitis due to diabetic heel ulcers. Additionally, secondary outcomes such as secondary TC following PC, secondary below knee amputation (BKA), mortality and the change in the ambulation status were analyzed.MethodsMedline, Scopus, Web of science, Cochrane Library and Google Scholar were searched since inception. All types of study design were included. Single case report studies and studies reporting osteomyelitis due to other etiologies than DFU were excluded.ResultsTwenty studies met the inclusion criteria comprising 295 patients with 300 calcanectomies (270 PC and 30 TC). With a mean follow-up period of 29.3 ± 17.7 months, the weighted results were as follows: a) the osteomyelitis healing rate was of 80% (95% CI = 0.728 to 0.861, I² = 48.3%), b) the rate of secondary total calcanectomy was of 5.4% (95% CI = 0.022 to 0.097, I² = 7.5%), c) the rate of secondary BKA was of 17.1% (95% CI = 0.111 to 0.241, I² = 50.6%) with no difference between subgroups of TC and PC, and d) the combined mortality rate of both calcanectomies was of 13.4% (95% CI = 0.064 to 0.224, I² = 73.6%); however, significant higher mortality was found following TC compared to PC (p < 0.0001).ConclusionPartial and total calcanectomies were found to yield very good healing rates with acceptable complication frequencies. When compared to the reported outcomes of below and above-knee amputations in the literature, calcanectomies could be fairly considered as good alternatives to above ankle amputations.     

Quimioterapia con estramustina en el manejo del cáncer de próstata resistente a la castración: metaanálisis de ensayos controlados aleatorizados

ObjectiveEstramustine, an agent with both hormonal and non-hormonal effects in men, is supposed to be effective in treating castration-resistant prostate cancer. However, previous studies have reported conflicting results. We conducted this meta-analysis to evaluate the efficacy and toxicity of additional estramustine to chemotherapy.MethodsData sources including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register were searched to identify potentially relevant randomized controlled trials. Prostate specific antigen (PSA) response, overall survival, and grade 3 to 4 toxicity were analyzed.ResultsSeven randomized controlled trials, a total of 839 patients, were enrolled. The pooled odds ratio for PSA response was 3.02 (95% CI = 1.69-5.39, P = .0002); the pooled hazard ratio for overall survival was .95 (95% CI = .80-1.14, P = .58); the pooled odds ratio for nausea/vomiting and cardiovascular toxicity were 3.90 (95% CI = 1.05-14.45, P = .04) and 2.22 (95% CI = 1.15-4.30, P = .02). No significant difference was detected for neutropenia, anemia, thrombocytopenia, diarrhea, fatigue, or neuropathy (P > .05).ConclusionsAccording to this meta-analysis, chemotherapy with additional estramustine increased the PSA response rate. However, it increased the risk of grade 3 or 4 adverse effects such as nausea/vomiting and cardiovascular events, and the overall survival was not improved for castration-resistant prostate cancer patients.     

A meta-analysis of the efficacy of raloxifene on all clinical and vertebral fractures and its dependency on FRAX®

IntroductionMultiple Outcomes of Raloxifene Evaluation (MORE), a placebo controlled phase III study of raloxifene in postmenopausal osteoporosis, showed that both doses tested (60 mg and 120 mg daily) reduced the risk of vertebral fracture. There was no significant effect on non-vertebral fracture.AimsThe aim of the present study was to evaluate the distribution of fracture risk assessed at baseline using the FRAX® tool in MORE and to determine the efficacy of raloxifene as a function of baseline fracture risk. The effects of raloxifene (60 and 120 mg daily combined) with placebo on the risk of all clinical fractures as well as the risk of morphometric vertebral fracture were examined as a function of baseline fracture risk.MethodsBaseline clinical risk factors and BMD were entered in the FRAX® model to compute the 10-year probability of major osteoporotic fractures. The interaction between fracture probability and treatment efficacy was examined by Poisson regression.ResultsThe 10-year probability of major osteoporotic fractures (with BMD) ranged from 0.9% to 77.2%. The incidence of clinical fractures and morphometric vertebral fractures increased with increasing baseline fracture probabilities. Treatment with raloxifene was associated with an 18% decrease in all clinical fractures compared to placebo treatment (hazard ratio HR = 0.82; 95% CI = 0.71–0.95; p = 0.0063) and a 42% decrease in incident morphometric vertebral fractures (HR = 0.58; 95% CI = 0.48–0.69; p < 0.001). Efficacy was shown over the whole range of fracture probability and the interaction between fracture probability and treatment was not significant. The efficacy or raloxifene on vertebral fracture risk was significantly greater at lower ages. At the 90th percentile of age (75 years) vertebral fracture risk was reduced by 31% irrespective of FRAX® probabilities. In contrast at younger ages, efficacy was higher and increased further still with decreasing fracture probability.ConclusionWe conclude that raloxifene (60 and 120 mg doses combined) significantly decreased the risk of all clinical fractures and morphometric fractures in women. Overall, there was no significant interaction between efficacy and fracture probability. In the case of morphometric vertebral fractures efficacy decreased significantly with increasing age.     

Modelling deterioration of foot health in older people following discharge from NHS podiatry services

BackgroundPodiatry services across the country have different access criteria for treatment and increasing pressure on resources has led to increasing moves to ‘treat and discharge’ rather than retaining patients for regular monitoring.AimThis study seeks to model the probability of the development of a medium or high risk foot pathology following discharge from NHS podiatry services.MethodClinical foot health data were collected from 343 patients aged 65 years and over who had been discharged from NHS podiatry services and who had a ‘low risk’ podiatric condition. These patients were followed up at approximately 8 monthly intervals and a maximum of 3 assessments per patient were obtained (on 247 patients). A logistic regression analysis was performed to predict the probability of developing a medium or high risk podiatric complaint within the time limit of the study (mean time from discharge to completion of third assessment = 26 months, S.D. = 8.7 m).ResultsEleven percent of the sample developed high-risk conditions and 4% developed medium risk conditions within the time of the study. Three risk factors were found for the development of medium to high-risk pathology. These were low levels of independence (OR = 0.65, 95% CI = 0.45–0.94), age at discharge (OR = 1.069, 95% CI = 1.003–1.139) and a diabetes/age interaction.ConclusionsLogistic regression analysis allows risk factors for deterioration of foot health after discharge from NHS podiatry services to be identified. The main risk factors are related to lack of independence, age and having diabetes. The study found a relatively high proportion of older people deteriorated rapidly without professional surveillance. The results of this study indicate that regular foot health monitoring would prevent undetected deterioration and should be targeted at older age groups, at those who have decreased levels of independence and those with diabetes.     

Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies

PurposeAchilles injuries are very common, mainly among young athletes. When indicated, the surgical treatment aims for strong repairs that can resist distraction and consequently ruptures. The majority of the published clinical meta-analyses reported comparisons between broad treatment modalities such as conservative treatment, open, and minimally invasive surgery.MethodsA meta-analysis has been conducted to assess further clinical and biomechanical variables on human cadavers related to the efficacy of Achilles repair. A total of 26 studies with 596 legs met the inclusion criteria. The maximal load to failure was set as the primary outcome. Eleven studies were amenable to meta-analysis.ResultsIn the reinsertion group, the analysis of the single row vs. double row subgroup showed a significantly higher strength for the latter (1.27, 95% CI = 0.748–1.806, I² = 81%, P < 0.0001). In the mid-tendon repair group, the Achillon vs. Krackow sutures and the Bunnell vs. Krackow sutures subgroups showed no difference while the Bunnell and Krakow sutures were significantly stronger than the Kessler sutures (0.96, 95% CI = 0.510–1.405, I² = 63.3%, P < 0.0001 and 1.37, 95% CI = 2.286–0.468, I² = 83.4%, P = 0.003; respectively).ConclusionsThe assessment of heterogeneity located variables such as age, suture/material type, number of strands, type of testing machine and software, preloading, ankle position and loading type as potential confounders. The results of this meta-analysis are likely to have a significant impact in clinical practice.     

Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic review of randomised controlled trials

BackgroundAnkle syndesmotic injuries can be surgically managed with syndesmosis screws (SS) or suture button (SB) fixation. We performed a meta-analysis of randomized controlled trials (RCTs) aiming to compare the clinical and complication profiles of both modalities.MethodsA multi-database search up to 4th of March 2018 was performed according to PRISMA guidelines. All RCTs comparing both techniques and published in English were included.ResultsFive RCTs with a total of 280 patients (140 SB, 140 SS) were included for analysis. SB had a statistically significant higher AOFAS score at 1 year (mean difference = 5.46, 95% CI = 0.40–10.51, p = 0.03) and lower implant failure rate (OR = 0.03, 95% CI = 0.01–0.15, p < 0.001). Infection and wound issues were marginally higher with SB (OR = 1.4, 95% CI = 0.4–4.85, p = 0.60). No other parameters showed statistically significant difference.ConclusionsBoth constructs yielded similar clinical outcomes. The 1 year AOFAS score was higher in SB but clinical significance is unlikely. SB had significantly fewer implant failures.Level of evidence: Level I.     

Osteoporosis risk and bone mineral density levels in patients with Parkinson's disease: A meta-analysis

IntroductionParkinson's disease (PD) and osteoporosis are common diseases which affect a substantial portion of the elderly population. Accumulating evidence supports that PD patients have a high risk for osteoporosis in recent years. The purpose of the present study is to perform a meta-analysis on the risk of osteoporosis and bone mineral density (BMD) levels in PD patients.MethodsWe searched all articles indexed in Medline, SciVerse Scopus and Cochrane Library published up to January 2012 concerning the association between PD and risk of osteoporosis or BMD levels. In total, 15 studies were included in the meta-analysis.ResultsThe results indicated that PD patients are at higher risk for osteoporosis (summary OR = 1.18, 95% CI = [1.09, 1.27]) than healthy controls. The gender subgroup analysis suggested that PD male patients have a higher risk for osteoporosis than female patients (female patients: summary OR = 1.16, 95% CI = [1.07, 1.26]; male patients: summary OR = 2.44, 95% CI = [1.37, 4.34]). Further meta-analysis showed that PD patients have a lower hip, lumbar spine and femoral neck BMD than healthy controls. The gender subgroup analysis found a lower BMD in PD female patients than controls, while no obvious difference was observed in PD male patients and controls.ConclusionsThis meta-analysis suggested that PD patients are at higher risk for osteoporosis and have lower BMD levels than healthy controls overall.     

Bone and body segment lengthening and widening: A 7-year follow-up study in pubertal girls

During growth bone increases in length and width as does the body size. The aim of this paper was to examine the growth pattern of body height and weight, and the width and length of various body segments, and to establish the timing of peak growth velocity (PV) in relation to time of menarche in a cohort of Finnish girls followed from age 10 until 18.The study was a 7-year longitudinal cohort study. Widths and lengths of body segments and bones were measured from DXA scan images using bone landmarks in 396 girls aged 10 to 13 years at baseline, and in 255 mothers and 159 grandmothers. The girls' growth velocities (rate of change with time) peaked at 13.5 months prior to menarche for height, 14.4 months for weight, and 15.4 months for BMI. Shoulder width peaked at 18.2 months, lesser pelvis width at 13.5 months and greater pelvis width at 11.6 months prior to menarche. The PV of various body segment lengths showed that the femur peaked earliest at 20.7 months prior to menarche, followed by the humerus (at 18.0 months), radius (at 17.4 months), tibia (at 17.5 months), and trunk (at 11.8 months), respectively. All the long bones were linearly correlated with height while the flat and irregular bones had a nonlinear growth relationship with height (r² = 0.73–0.88). By the age of 18 years the girls had reached their mothers' height (101%) and humerus, radius, femur and tibia lengths (100–101%), but not their mothers' shoulder, great pelvis and lesser pelvis widths (98%, 95% and 93%, respectively). Our data confirmed that, after bone elongation had ceased, segment width continued to increase, although at a slower speed, into early adulthood. The wide variations in growth velocity of these anthropomorphic measurements underscore the need to optimize nutrition and physical activity from early puberty onward in order to maximize bone development.     

¿Es útil la puntuación de Guy para predecir resultados en la nefrolitotomía percutánea?

IntroductionPercutaneous Nephrolithotomy (PCNL) is currently the treatment of choice in large kidney stones. Guýs stone score was developed to predict treatment outcomes. The aim of this study was to evaluate the relationship between Guýs score and outcomes in our institution.Materials and MethodsThe medical records of patients diagnosed with urolithiasis and treated by PCNL were retrospectively evaluated between January 2017 and December 2018. Analyzed data included: age, sex, Guy's score based on preoperative findings, transfusion, stone-free rate and requirement of auxiliary procedures. Chi-square test was used for the comparison of proportions. Odds ratios (OR) with confidence intervals (CIs) of 95% were calculated by logistic regression.ResultsA total of 386 patients, 53.89% female, mean age of 45.59 ± 15 years were analyzed. Guy's score was as follows: 112 patients (29.04%) were classified as Guy I, 92 patients (23.82%) as Guy II, 94 patients (24.34%) as Guy III, and 88 patients (22.80%) as Guy IV. There were no differences between groups in terms of blood transfusions. Stone-free rate was 96.43% (n = 108) for patients Guy I; 84.78% (n = 72) for Guy II; 76.59% (n = 72) for Guy III and 50% (n = 44) for Guy IV categories (p < 0.0001). Taking as a reference Guy I group, the OR to require new treatment for residual stones were: Guy II 4.85 (CI = 0.95 to 24.60, P = 0.05) to Guy III 8.25 (CI = 1.73 to 39.44, P = 0.008) and Guy IV 27 (CI = 5.84 to 124.70; p < 0.0001).ConclusionThere was a statistically significant association between Guýs Score and stone-free rates following PCNL. Guy's score was useful to predict results of PCNL in our group.     

Frailty as a predictor of fractures among community-dwelling older people: A systematic review and meta-analysis

PurposeTo identify prospective studies examining associations between frailty and fractures and to combine the risk measures to synthesize pooled evidence on frailty as a predictor of fractures among community-dwelling older people.MethodsA systematic literature search was conducted using five databases: Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library for prospective studies on associations between frailty and fracture risk published from 2000 to August 2015 without language restriction. Odds ratios (OR) and hazard ratios (HR) extracted from the studies or calculated from available data were combined to synthesize pooled effect measures using random-effects or fixed-effects models. Heterogeneity, methodological quality, and publication bias were assessed. Meta-regression analyses were performed to explore the cause of high heterogeneity.ResultsOf 1305 studies identified, six studies involving 96,564 older people in the community were included in this review. Frailty and prefrailty were significantly associated with future fractures among five studies with OR (pooled OR = 1.70, 95% confidence interval (95% CI) = 1.34–2.15, p < 0.0001; pooled OR = 1.31, 95% CI = 1.18–1.46, p < 0.00001, respectively) and four studies with HR (pooled HR = 1.57, 95% CI = 1.31–1.89, p < 0.00001; pooled HR = 1.30, 95% CI = 1.12–1.51, p = 0.0006, respectively). High heterogeneity was observed among five studies with OR of frailty (I² = 66%). The studies from the United States were found to have a higher fracture risk than from those from other countries in a meta-regression model (regression coefficient = 0.39, p = 0.04). No evidence of publication bias was identified.ConclusionsThis systematic review and meta-analysis showed evidence that frailty and prefrailty are significant predictors of fractures among community-dwelling older people. Treating frailty may potentially lead to lowering fracture risks.     

Implementación de un programa de cribado del malestar emocional en un servicio de cirugía torácica

IntroductionThe aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery.MethodsEmotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: «Are you depressed?» (Depression Question, ADEP) (1-5) and the single-item interview: «Are you anxious?» (Anxiety Question, ANXQ) (1-5).ResultsAccording to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity = 0.89, specificity = 0.75 and AUC = 0.883; the ADEP scale (>1) showed a sensitivity = 0.79, specificity = 0.74 and AUC = 0.795; the ANXQ scale (>1) showed a sensitivity = 0.78, specificity = 0.41 and AUC = 0.690; and the physician's opinion showed a sensitivity = 0.47 and specificity = 0.86.ConclusionsA high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy.     

Improvement in clinical markers in CF patients using a reduced glutathione regimen: An uncontrolled,observational study

CFTR mutation, which causes cystic fibrosis (CF), has also recently been identified as causing glutathione system dysfunction and systemic deficiency of reduced glutathione (GSH). Such dysfunction and deficiency regarding GSH may contribute to the pathophysiology of CF. We followed 13 patients (age range 1–27 years) with cystic fibrosis who were using a regimen of reduced glutathione (GSH), including oral glutathione and inhaled buffered glutathione in an uncontrolled, observational study. Dosage ranged from 66–148 mg/kg/day in divided doses, and the term examined was the initial 5.5 months of GSH use (45 days of incrementally adjusted dose, plus 4 months of use at full dosage). Baseline and post-measurements of FEV1 percent predicted, BMI percentile, and weight percentile were noted, in addition to bacterial status and pulmonary exacerbations. Significant improvement in the following clinical parameters was observed: average improvement in FEV1 percent predicted (N = 10) was 5.8 percentage points (p < 0.0001), average weight percentile (N = 13) increased 8.6 points (p < 0.001), BMI percentile (N = 11) improved on average 1.22 points (p < 0.001). All patients improved in FEV1 and BMI, if measured in their case; 12 of 13 patients improved in weight percentile. Positive sputum cultures of bacteria in 11 patients declined from 13 to 5 (p < 0.03) with sputum cultures of Pseudomonas aeruginosa becoming negative in 4 of 5 patients previously culturing PA, including two of three patients chronically infected with PA as determined by antibody status. Use of a daily GSH regimen appears to be associated in CF patients with significant improvement in lung function and weight, and a significant decline in bacteria cultured in this uncontrolled study. These findings bear further clinical investigation in larger, randomized, controlled studies.     

Análisis de la pérdida ponderal a medio plazo después del bypass gastroyeyunal en Y de Roux y de la gastrectomía vertical: propuesta de gráficos de percentiles del porcentaje de peso total perdido para su uso en la práctica clínica diaria

IntroductionThe aim of this study is to analyze weight evolution after the main bariatric surgical techniques (Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]) performed at a representative sample of Spanish hospitals in order to develop percentile charts for the percentage of total weight loss during the first 3 years after surgery.MethodsA retrospective longitudinal cohort study was conducted based on the data provided by 9 Spanish hospitals. Weight data were analyzed both in % total weight loss and % excess weight lost corresponding to the RYGB (n = 1,887) and SG (n = 1,210).ResultsRYGB continues to be the most frequently performed technique in our sample. In both surgical techniques, maximum weight loss occurred 18 months after surgery. Both techniques followed the same weight evolution, although the % total weight loss values were lower in the case of the SG after 36 months (29.3 ± 10 vs. 33.6 ± 10). Age and gender are decisive in the weight results (better in younger patients for both techniques and better in women for RYGB).ConclusionsPercentile charts of % total weight loss after bariatric surgery represent a very useful tool and an important advance in the quality of patient management.