Osteoporotic hip fractures (OHF) are not limited to elderly; however, studies in non-elderly are scarce. Thus, the aim of this study was to evaluate co-morbidities in non-elderly patients with OHF in a Community Teaching Hospital. All hospitalizations due to OHF during a 3-year period in a Community Teaching Hospital were retrospectively evaluated for co-morbidities, and patients 18-64 years old were compared with those ≥65 years old. Of all hospitalizations, 232 (0.73%) were due to hip fractures, and 120/232 (51.7%) patients had OHF. The comparison of the 13 (10.8%) OHF patients <65 years old (47.3 ± 9.7 years) with 107 (89.2%) ≥65 years old (80.4 ± 7.7 years) revealed a male predominance (61.5 vs. 27.1%, P = 0.022) and a distinct ethnic distribution with a lower proportion of Caucasians in the former (61.5 vs. 86.9%, P = 0.033). Moreover, non-elderly OHF patients had higher frequencies of insulin-dependent DM (38.5 vs. 3.7%, P = 0.001) and alcoholism (38.5 vs. 4.7%, P = 0.001) than aged patients. In contrast, rates of age-related co-morbidities such as stroke (7.7 vs. 18.7%, P = 0.461), heart failure (23.1 vs. 14.0%, P = 0.411), and dementia (7.7 vs. 15.9%, P = 0.689) were comparable in both groups. Logistic regression analysis demonstrated that insulin-dependent DM (OR = 25.4, 95% CI = 4.7-136.8, P < 0.001) and alcoholism (OR = 20.3, 95% CI = 3.9-103.3, P < 0.001) remained as independent risk factors for OHF in non-elderly patients. Osteoporosis is an important cause of HF in Community Hospital. Non-elderly patients with OHF have a peculiar demographic profile and associated co-morbidities. These findings reinforce the need of early osteoporosis diagnosis and rigorous fracture prevention in patients with DM and alcoholism.
Chronic meningococcemia is a rare clinical presentation within the spectrum of infections due to Neisseria -en.jpg-en.jpgmeningitidis, which was first described in 1902. It is defined as a chronic and benign meningococcal bacteremia without meningeal signs or symptoms with at least one week’s duration, characterized by intermittent or continuous fever, polymorphic cutaneous rash, and migratory arthropathy. The incidence is believed to be around 1:200,000 inhabitants. It affects predominantly young people and adults, and it is equally distributed between genders. Diagnosis may be challenging in the early stages of the disease because of the difficulty in isolating Neisseria -en.jpg-en.jpgmeningitidis (it reaches 74% of positivity in advanced stages). Recently, the use of PCR for detecting Neisseria -en.jpg-en.jpgsp antigen in skin biopsies specimens has been considered for those culture-negative cases. The authors report a case of a 54-year-old female patient who sought medical attention for a five-day fever followed by arthralgia and skin lesions predominantly in the lower limbs. The patient progressed to a toxemic clinical status that improved after the administration of antibiotic therapy, which consisted of oxacillin and ceftriaxone. The diagnosis of chronic meningococcemia was performed after the isolation of Neisseria meningitidis in two different blood sample cultures. This is, to our knowledge, the first case of chronic meningococcemia described in Brazil (up to the writing of this report).
a minha vida. O Motivo, a Paz e a Alegria que me norteia e impulsiona a cada passo, porque me sustenta com sua destra fiel. Aos meus pais, Lyba e Mituo, a quem devo muito mais do que a minha existência. Grandes guerreiros, batalhadores insistentes que, com muito sacrifício, empenho e esforço, nos proporcionaram uma educação de qualidade e, principalmente, a formação e lapidação do nosso caráter. Responsabilidade, perseverança, lealdade, humildade, compaixão e amizade foram valores que nos incutiram desde criança. Dedico também ao meu amado esposo Carlos, amigo, companheiro, conselheiro, pai exemplar... Compartilhamos tantos momentos de alegrias e vitórias..., também alguns recheados de lágrimas e dor, e a cada dia descubro e aprendo quão maravilhoso é sermos um. Em mim se consolida a certeza de que nossa jornada juntos é bem mais leve do que separados. Às minhas filhas, Priscila e Lídia, tesouros preciosos que coroam a vida de alegria a cada momento, a cada abraço, a cada sorriso, anjos enviados por Deus que nos fazem acreditar que o mundo ainda pode ser melhor e que ainda devemos batalhar por ele. Agradecimentos Ao meu orientador, Prof. Dr. Paulo Andrade Lotufo, por ter me aceito como sua orientanda, por sua paciência e dedicação em todos os momentos, mesmo com tantos afazeres e obrigações, mas principalmente na minha formação acadêmica e profissional. Ao Prof. Dr. Paulo Menezes e a Profa. Dra. Márcia Scazufca, que permitiram que eu trabalhasse no seu projeto, dando um grande estímulo em todas as etapas.
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