Tendinitis aquílea en el anciano

IntroducciónLas quinolonas son un grupo de agentes antibacterianos sintéticos relacionados estructuralmente con el ácido nalidíxico1. Atendiendo al espectro antibacteriano se clasifican en quinolonas no fluoradas o de primera generación (ácidos nalidíxicos, pipemídico y oxolínico), que tienen un espectro limitado y no alcanzan niveles sistémicos eficaces; fluoroquinolonas de segunda generación (ciprofloxacino, norfloxacino, ofloxacino y perfloxacino), con gran potencia frente a gramnegativos incluidas Pseudomonas, y fluoroquinolonas de tercera generación (levofloxacino y moxifloxacino), con actividad frente a microorganismos grampositivoso y gramnegativos y atípicos. Entre las precauciones que se deben tener en cuenta al prescribir este grupo terapéutico están el evitar la exposición solar prolongada por la fototoxicidad que ocasionan y restringir su uso en niños y adolescentes por la afección del cartílago de crecimiento2.Caso clínicoVarón de 74 años que acudió a nuestra consulta al presentar de forma brusca dificultad a la deambulación por dolor en el pie izquierdo de 48 h de evolución que posteriormente se hizo bilateral. No refería ningún sobreesfuerzo físico ni traumatismo directo y no mejoró tras la toma de antiinflamatorios. En la exploración física no se observaba deformidad, hematoma ni inflamación en ambos tobillos, y destacaba el dolor selectivo en ambos tendons aquíleos, así como la limitación de la flexión dorsal del pie. Al repasar la historia clínica se comprobó que se trataba de un paciente alérgico a las penicilinas y asmático en tratamiento habitual con una inhalación cada 12 h de salmeterol 50 μg/fluticasona 250 μg, y que en ocasiones había necesitado pautas de corticoides por vía oral. Había sido tratado hacía 4 días por una reagudización asmática leve secundaria a una bronquitis aguda, para cuyo tratamiento se aconsejó doblar la dosis de los broncodilatodores y añadir moxifloxacino 400mg/24 h/5 días. Ante la sospecha de una reacción adversa medicamentosa secambió la antibioterapia, y desde entonces el paciente notó una mejoría progresiva de su cuadro clínico. El hecho se notificó al Centro de Farmacovigilancia.Discusión y conclusionesLa tendinitis se considera un efecto adverso poco frecuente del grupo de las quinolonas que puede ocasionar rotura del tendón en el 31% de los casos. El tendón de Aquiles es el más afectado y hasta en un 50% de los casos la afección es bilateral3. La sintomatología aparece dentro de las primeras 2 semanas de tratamiento y cede espontáneamente al retirar la medicación, aunque hasta en un 11% de los pacientes puede persistir 2 meses después. Un número importante de pacientes suele ser anciano y/o recibe tratamiento con corticoides4

Hypertension as a Risk Factor for Hip Fracture

Producción CientíficaArterial hypertension is a chronic disease in which prevalence increases with age, as occurs in osteoporosis. It is clinically silent and is only revealed in the form of complications, an aspect that it also shares with osteoporosis. Various alterations of calcium metabolism have been described in association with hypertension; such alterations can cause decreased bone mass, the principal determining factor of fracture.1,2 Another important factor is the occurrence of falls. Hypertensive patients may experience a greater number of falls resulting from fainting associated with diminished baroreflex sensitivity or hypotension secondary to therapy.3,4 The purpose of this study was to assess the effect of hypertension and its various therapeutic alternatives on the risk of hip fracture.2015-09-0

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Amphibians in the diet of European Barn Owls

We present a review of the propensity to eat amphibians in the Barn Owl Tyto alba in Europe. Based on the analysis of 596 published studies reporting 3.32 million prey items identified in pellets, 17 869 amphibians (0.54%) were found. An analysis of 9036 amphibians identified to the species level showed that Barn Owls avoid consuming toxic species, and they are able to capture tree frogs (Hylidae) only rarely. The true frogs (Ranidae) are by far the most frequently captured amphibians followed by spadefoot toads (Pelobatidae) and Parsley frogs (Pelodytidae)