These findings justify the need to assure adequate vitamin D intake in patients being treated with anticonvulsants, independently of the treatment, age, sex, and activity status, in order to prevent osteomalacia.

No abstract

Study design: A cross-sectional study. Objective: To clarify the existing controversy with regard to whether paraplegic patients suer a loss of bone mass in the upper limbs. Setting: Madrid, Spain. Methods: We evaluated bone mass by phalangeal ultrasonography in 35 male patients with paraplegia (mean age 49+12 years), and 25(OH)D3 and PTH to exclude the presence of osteomalacia and secondary hyperparathyroidism. Spasticity was evaluated according to the Ashworth scale. Patients were compared with a control group of 35 healthy male subjects (mean age 48+13 years). Results: The patients had lower 25(OH)D 3 levels and amplitude-dependent speed of sound (Ad-SOS) than controls (both P50.001), and higher PTH levels (P50.05). There was a statistically signi®cant negative association between PTH and 25(OH)D 3 levels (r=70.52, P50.0001, CI 70.73 to 70.22) and between 25(OH)D 3 and injury duration (r=0.34, P50.05, CI 70.60 to 70.01). There was no correlation between Ad-SOS values, levels of PTH or 25(OH)D 3 , and the injury duration. No signi®cant dierence in Ad-SOS values was found in patients grouped according to low-to-normal 25(OH)D 3 level or according to normal-to-high PTH level. There were no dierences in relation to muscle tone. Only alkaline phosphatase and tartrate-resistant acid phosphatase levels were higher in patients than in controls (both P50.001). Conclusion: Paraplegic patients had a loss of phalangeal bone mass that was unrelated to the levels of vitamin D or PTH, or to muscle tone, so it seems to be related to increased bone resorption rather than to de®cient bone formation.

In patients with CD, gluten-free diet and increased nutritional intake were accompanied by normal bone mass values as determined by ultrasound on phalanges.

BackgroundSmokers undergoing surgery are at a higher risk of complications than non-smokers. Preoperative evaluation by an anesthesiologist could provide an excellent opportunity to promote smoking cessation. Previous surveys of anesthesiologists have found that self-reported smoking cessation counseling rates have room for improvement, but no study has surveyed patients to obtain more accurate estimates.MethodsA single-center study was conducted from January 2010 to June 2010 in a tertiary teaching hospital. A telephone survey was conducted, which included all adult cigarette smokers who visited the preoperative anesthesia clinic. The survey recorded anesthesiologist-delivered interventions to help patients quit smoking before surgery. At the end of the study period, the self-reported smoking cessation counseling of the anesthesiologist was evaluated by questionnaire.ResultsOne thousand one hundred and sixty-five patients were evaluated, of which 217 were current smokers with a median pack-year of 15 (interquartile range 5.25–30.00) and 34% were scheduled to undergo major surgery. With regard to preoperative interventions, most anesthesiologists (85%) asked about smoking status, although only 31% advised patients about the health risks of smoking and 23% advised patients to quit before surgery. Provision of assistance to help patients quit was provided in 3% of cases. By contrast, 75% of anesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking.ConclusionsThis study shows significant discrepancies between direct patient surveys of preoperative smoking cessation counseling activities by anesthesiologists and the self-reported perceptions of the anesthesiologists. Future studies are urgently needed to evaluate the provision of educational materials and other interventions to improve smoking cessation counseling rates among anesthesiologists and to narrow these discrepancies.