Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

An overview of reviews on strategies to reduce health inequalities.

BACKGROUND: Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions. OBJECTIVE: Identify and synthesize strategies or interventions that facilitate the reduction of health inequalities. METHODS: A systematic search strategy was carried out up until August 2019 in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, LILACS, Scopus, Scielo and Epistemonikos. In addition, a snowball strategy was used. Literature reviews (LRs) of experimental and quasi-experimental studies were included. The identified interventions and outcomes were categorized based on the recommendation by the Cochrane group in "Effective Practice and Organization of Care". The quality of the included LRs was evaluated using the AMSTAR 2 tool. RESULTS: Four thousand ninety-five articles were identified, of which 97 were included in the synthesis of evidence. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes. CONCLUSION: The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.

Efectividad de las estrategias de transferencia de conocimiento en lenguaje audiovisual comparadas con otras para mejorar desenlaces en la salud individual y de la población general: revisión sistemática / Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review

RESUMEN Introducción: La transferencia del conocimiento (KT) corresponde no solo a una serie de accio nes finales en áreas de divulgación, sino a la identificación de estrategias para la realización de este proceso. Objetivo: Evaluar la efectividad de estrategias de KT en lenguaje audiovisual comparadas con otros lenguajes para mejorar los desenlaces en salud de la población general. Métodos: Se realizó una búsqueda en MEDLINE, CENTRAL, PsycARTICLES, WHO International Clinical Trials Registry Platform, EMBASE y LILACS. Resultados: Se incluyeron 63 estudios; se observó gran variabilidad en las poblaciones de estudio, así como en los lenguajes comparados con el lenguaje audiovisual y los instru mentos de medición. Los estudios tienen alto riesgo de sesgo y la calidad de la evidencia identificada no permite llegar a una conclusión respecto a la efectividad de los lenguajes evaluados en KT. Conclusiones: Se identifican diferentes lenguajes que pueden emplearse para transferir cono cimientos. Se evidencia que el conocimiento y los efectos producidos por la intervención disminuyen a medida que avanza el tiempo, independientemente del tipo de lenguaje empleado. Por lo tanto, es el tiempo es un punto importante a tener en cuenta en este tipo de intervenciones.

ABSTRACT Background: Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process. Objective: To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population. Methods: We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO Interna tional Clinical Trials Registry Platform, EMBASE and LILACS. Results: We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation. Conclusions: We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time pro gresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review. / Efectividad de las estrategias de transferencia de conocimiento en lenguaje audiovisual comparadas con otras para mejorar desenlaces en la salud individual y de la población general: revisión sistemática.

BACKGROUND: Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process. OBJECTIVE: To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population. METHODS: We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO International Clinical Trials Registry Platform, EMBASE and LILACS. RESULTS: We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation. CONCLUSIONS: We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time progresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

Importance of selection and duration of antibiotic regimen in prosthetic joint infections treated with debridement and implant retention.

OBJECTIVES: Early prosthetic joint infections (PJIs) are managed with debridement, implant retention and antibiotics (DAIR). Our aim was to evaluate risk factors for failure after stopping antibiotic treatment. METHODS: From 1999 to 2013, early PJIs managed with DAIR were prospectively collected and retrospectively reviewed. The main variables potentially associated with outcome were gathered, and the minimum follow-up was 2 years. For the present study, only patients who were in remission after one debridement and without long-term antibiotic suppression were included. The primary endpoint was implant removal or the need to reintroduce antibiotic treatment due to failure. RESULTS: One-hundred-and-forty-three patients met the inclusion criteria. The failure rate after a median duration of oral antibiotic treatment of 69 days (IQR 45-95 days) was 11.8%. In 92 cases, PJI was due to Gram-positive microorganisms, in 21 cases PJI was due to Gram-negative microorganisms and in 30 cases PJI was due to a polymicrobial infection with both Gram-positive and Gram-negative microorganisms. In Gram-positive infections, rifampicin administered in combination with linezolid, co-trimoxazole or clindamycin was associated with a higher failure rate (27.8%, P = 0.026) than that in patients receiving a combination of rifampicin with levofloxacin, ciprofloxacin or amoxicillin (8.3%) or monotherapy with linezolid or co-trimoxazole (0%). Among patients with a Gram-negative infection, the use of fluoroquinolones was associated with a lower failure rate (7.1% versus 37.5%, P = 0.044). CONCLUSIONS: The only factor associated with failure was the oral antibiotic selection, not the duration of treatment. Linezolid, co-trimoxazole and clindamycin, but not levofloxacin, serum concentrations are reduced by rifampicin; a fact that could explain our findings. Further studies monitoring serum concentration could help to improve the efficacy of these antibiotics when administered in combination with rifampicin.

Transfusion of packed red blood cells stored >14 days was associated with a higher risk of infection after hip revision arthroplasty.

PURPOSE: Transfusion of packed red blood cells (RBCs) stored for >14 days has been associated with a higher risk of infection but there is no data about the impact in revision hip arthroplasty. METHODS: We retrospectively reviewed 280 patients who underwent revision hip arthroplasty from January 2002 to May 2012. Relevant risk factors and prosthetic joint infection (PJI) rate after 100 days after surgery were collected. RESULTS: 10 patients out of 280 (3.6%) had a PJI within the first 100 days after revision surgery. The PJI rate in patients receiving an early transfusion (during surgery or within the first 12 hours) of packed RBCs with a length of storage >14 days was higher (8.0%) than the rate in nontransfused patients (1.8%) or those receiving an early transfusion of packed RBCs with a length of storage ≤14 days (2.6%, p = 0.05). A Cox regression model identified transfusion of packed RBCs stored >14 days as the only independent predictor of PJI (hazard ratio [HR] = 4.54; 95% confidence interval [CI], 1.13-18.15; p = 0.032). CONCLUSIONS: The only independent predictor of PJI was early transfusion of packed RBCs stored >14 days. Therefore, a potential way for reducing the PJI rate could be the selection of young packed RBCs.