Sociodemographic Determinants for the Health-Related Quality of Life of Patients with Vascular Amputations as Determined with the Prosthesis Evaluation Questionnaire.

BACKGROUND: To identify the sociodemographic variables independently related to the different dimensions of the Prosthesis Evaluation Questionnaire (PEQ). METHODS: An observational, cross-sectional study was conducted, with a sample of 61 Spanish vascular amputees (Valencia, Spain). Included in this study are the results of the PEQ and explanatory-sociodemographic variables, as well as a descriptive and analytic analysis. RESULTS: Gender differences were observed in "appearance" and "perception of appearance" (significantly higher levels for men). Older patients tended to have worse scores in "utility", "frustration", "social burden" and "deambulation". More favorable scores were obtained for those residing in rural areas in "social burden" and "deambulation". Educational level had a positive correlation with scores. CONCLUSION: Gender, age, place of residence, and educational level could be considered determinants of the quality of health related to prosthesis adaptation in vascular amputees. CLINICAL RELEVANCE: Knowing the influential variables in the process of prosthetization will allow better adaptation and an improvement in the quality of life.

Validity and Reliability of Administrative Coded Data for the Identification of Hospital-Acquired Infections: An Updated Systematic Review with Meta-Analysis and Meta-Regression Analysis.

OBJECTIVE: To conduct an updated assessment of the validity and reliability of administrative coded data (ACD) in identifying hospital-acquired infections (HAIs). METHODS: We systematically searched three libraries for studies on ACD detecting HAIs compared to manual chart review. Meta-analyses were conducted for prosthetic and nonprosthetic surgical site infections (SSIs), Clostridium difficile infections (CDIs), ventilator-associated pneumonias/events (VAPs/VAEs) and non-VAPs/VAEs, catheter-associated urinary tract infections (CAUTIs), and central venous catheter-related bloodstream infections (CLABSIs). A random-effects meta-regression model was constructed. RESULTS: Of 1,906 references found, we retrieved 38 documents, of which 33 provided meta-analyzable data (N = 567,826 patients). ACD identified HAI incidence with high specificity (≥93 percent), prosthetic SSIs with high sensitivity (95 percent), and both CDIs and nonprosthetic SSIs with moderate sensitivity (65 percent). ACD exhibited substantial agreement with traditional surveillance methods for CDI (κ = 0.70) and provided strong diagnostic odds ratios (DORs) for the identification of CDIs (DOR = 772.07) and SSIs (DOR = 78.20). ACD performance in identifying nosocomial pneumonia depended on the ICD coding system (DORICD-10/ICD-9-CM  = 0.05; p = .036). Algorithmic coding improved ACD's sensitivity for SSIs up to 22 percent. Overall, high heterogeneity was observed, without significant publication bias. CONCLUSIONS: Administrative coded data may not be sufficiently accurate or reliable for the majority of HAIs. Still, subgrouping and algorithmic coding as tools for improving ACD validity deserve further investigation, specifically for prosthetic SSIs. Analyzing a potential lower discriminative ability of ICD-10 coding system is also a pending issue.

Meta-analysis of validity of echogenic intracardiac foci for calculating the risk of Down syndrome in the second trimester of pregnancy.

Echogenic intracardiac foci are a second trimester marker associated with aneuploidy in high-risk populations. The objective of this study is to assess the validity of echogenic intracardiac foci for Down syndrome detection in the second trimester ultrasound scan. A systematic search in major bibliographic databases was carried out (MEDLINE, EMBASE, CINAHL). Twenty-five studies about echogenic intracardiac foci were selected for statistical synthesis in this systematic review. Those 25 considered to be relevant were then subjected to critical reading, following the Critical Appraisal Skills Programme criteria, by at least three independent observers. Then, the published articles were subjected to a meta-analysis. A global sensitivity of 21.8% and a 4.1% false positive rate were obtained. The positive likelihood ratio was 5.08 (95% confidence interval, 4.04-6.41). The subgroups analysis did not reveal statistically significant differences. In conclusion, echogenic intracardiac foci as an isolated marker could be a tool to identify-rather than exclude-the high-risk group of Down syndrome, although it should be noted that it shows low sensitivity.

Spanish multicenter study to estimate the incidence of chronic pancreatitis.

OBJECTIVE: To estimate the incidence of chronic pancreatitis in Spain as diagnosed with endoscopic ultrasound (EUS), and to assess the risk factors and complications detected. MATERIAL AND METHOD: A descriptive, observational study of chronic pancreatitis cases diagnosed in Spanish health care centers with an EUS unit. A structured questionnaire was used to evaluate the incidence of the disease (cases identified over 18 months: from January 2011 to June 2012), risk factors, EUS criteria, Rosemont classification, and frequency of local complications. RESULTS: Twenty-three centers were selected serving a total reference area of 14,752,704 population. During the study period 1,031 chronic pancreatitis cases were diagnosed, with an incidence of 4.66 cases per 105 inhabitants/year (95% CI: 4.65-4.67). Tobacco and alcohol use appear as risk factors in 63.8% and 66.7% of cases, respectively. Of these, 53.3% met > 5 EUS criteria for chronic pancreatitis, and 69% had findings suggestive of or consistent with chronic pancreatitis according to the Rosemont classification. Most prevalent complications included calcifications (34.7%), pseudocysts (16%), and presence of an inflammatory pancreatic tumor (10.4%). CONCLUSIONS: The incidence of chronic pancreatitis in Spain is similar to that of other European countries. Given the widespread use of the technique, EUS units are key in detecting the disease, and their activity and results allow to estimate the incidence of chronic pancreatitis over wide, representative population areas.

Cross-cultural validation of the Prosthesis Evaluation Questionnaire in vascular amputees fitted with prostheses in Spain.

BACKGROUND: The lack of specific prosthetic-related outcome instruments for Spanish amputees must be addressed. OBJECTIVE: To elaborate a culturally equivalent version of the Prosthesis Evaluation Questionnaire in the Spanish language. STUDY DESIGN: Cross-cultural questionnaire validation. METHODS: Two-step process for cultural adaptation: forward and backward translations of English original and Spanish translated versions; assessment of both construct and criterion validity and reliability in a group of vascular amputees. RESULTS: A total of 61 patients were recruited, 44 men (72.1%) and 17 women (27.9%), with a median age of 71.1 years (standard deviation: 7.7 years; range: 51-87 years). In the Prosthesis Evaluation Questionnaire-Spanish, the lowest scores were for gait and frustration, and the highest scores were for noise and stump health. Internal consistency of the questionnaire was acceptable (>0.70) for four of the scales used in the Prosthesis Evaluation Questionnaire but poor (<0.50) for the scales relating to appearance and stump health. Correlations with the quality-of-life levels as measured by the Short Form-36 were positive and mostly significant. CONCLUSION: Prosthesis Evaluation Questionnaire-Spanish could assess the quality of life in patients who have undergone vascular amputations and then been fitted with a prosthetic limb. The questionnaire shows adequate criteria validity when compared with other instruments for measuring quality of life. CLINICAL RELEVANCE: The Prosthesis Evaluation Questionnaire-Spanish could be a valid and reliable instrument for assessing adaptation to prostheses in vascular amputees. The questionnaire adds information relevant to the patient and the physician and may identify cases with poor expected adaptation to the prosthesis.

A case-control study of post-traumatic endophthalmitis at a Spanish hospital.

Our aim was to identify the potential risk factors for developing post-traumatic endophthalmitis (PTE) and the possible measures of prevention. Retrospective case-control study, with 15 cases of PTE and 2 matched controls. We reviewed the medical records of the cases and their respective controls during the period 1996-2008 at a Spanish Hospital. We collected demographic data and information about the type of trauma, the potential risk factors, comorbidities, microbial isolations, antimicrobial susceptibility, administered treatments, and the visual outcome. The independent predictor factors identified for PTE were intraocular foreign body (IOFB) (OR 5.48; CI 95 % 1.05-28.7), dirty wound (OR 4.91; CI 95 % 0.96-25.3), and wound closure delays of 24 h or more (OR 5.48; CI 95 % 1.05-28.7). The probability of endophthalmitis in patients without these risk factors was 5.9 %, but ascended to 65.3 % and 90.3 %, in those patients with two and three risk factors, respectively. Infected patients presented a complication rate of 80 %, with an evisceration rate of 53 %; both were significantly associated with infection. The visual outcome was poor and related to the presence of IOFB and virulent microorganisms (Bacillus sp., filamentous fungus), visual acuity at presentation, and retinal detachment. Patients who presented an IOFB, dirty wound, and delayed wound closure were 15 times more likely to develop infection, and when infected, patients fared much worse than those non-infected. We thus recommend aggressive prophylactic measures in patients with these risk factors, adding antifungal prophylaxis when the injury is contaminated with vegetable matter.

Comparative effectiveness of ultrasonophoresis and iontophoresis in impingement syndrome: a double-blind, randomized, placebo controlled trial.

OBJECTIVE: To estimate the effectiveness of ultrasonophoresis and iontophoresis with sodium diclofenac used in addition to an exercise program for patients with impingement syndrome. DESIGN: Multicentre, double-blind, placebo randomized controlled trial. SETTING: "Mancha Centro" Outpatient primary care clinic (Spain). PARTICIPANTS: A total of 175 patients were considered, of whom 88 met criteria and agreed. INTERVENTION: The patients were randomly assigned to one of three groups: a) standard treatment (supervised exercises and cryotherapy) along with placebo iontophoresis and placebo ultrasonophoresis; b) standard treatment, iontophoresis, and placebo ultrasonophoresis; and c) standard treatment, ultrasonophoresis, and placebo iontophoresis. All patients received 15 treatment sessions. OUTCOME MEASURES: Baseline, 6-, and 12-week evaluations were carried out. Functionality, pain, range of motion, strength and quality of life were assessed with the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Constant-Murley score, and SF-36 scale. RESULTS: Ultrasonophoresis group experienced significant decreases in pain compared to the standard treatment group (12.7 and 13.5 points in "bodily pain" dimension of SF-36; and 1,5 and 2,2 points in "pain" dimension of Constant Murley after 6 and 12 weeks of therapy, respectively). They also reported improved range of motion compared to the exercises group (2,1 points in Constant-Murley after 6 weeks and 12 weeks), better vitality and overall health (SF-36 dimensions). Iontophoresis, however, led to no significant improvements when added to the standard treatment. CONCLUSION: In patients with impingement syndrome, a combination of ultrasonophoresis and an exercise program are better than a combination of iontophoresis and the same exercise program or the exercise program alone.

The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: the SEPD-SEMG national survey.

INTRODUCTION AND AIMS: The understanding of lactose intolerance (LI) is limited in some professional settings. Sociedad Española de Patología Digestiva (SEPD) and Sociedad Española de Medicina General (SEMG) have developed a survey in order to: a) Analyze primary care physicians (PCPs) knowledge and clinical management; and b) to compare results with those of a previous survey of Spanish gastroenterologists (GEs). MATERIAL AND METHODS: An online questionnaire was sent to SEMG members with 27 items on various issues: Demographics, occupational characteristics, outlook on LI, diagnostic tests, treatment, and follow-up. Results were compared to those from a survey of GEs. RESULTS: A total of 456 PCPs responded, versus 477 GEs. PCPs had an older mean age and longer professional experience. Level of understanding of LI was similar, albeit a higher proportion of PCPs lacked epidemiological awareness (p < 0.01). GEs tended to consider LI a "minor" condition (71.3 vs. 40.1%; p > 0.001), and LI symptoms as overlapping those of irritable bowel syndrome (93.5 vs. 88.2%; p = 0.005), although symptoms perceived as suspicious of LI were similar in both groups. Dietary recommendations were recognized as the primary therapeutic approach. CONCLUSION: This study reveals the outlook of PCPs on LI, and allows comparison with that of GEs, as a basis for the development of strategies aimed at improving LI understanding, approach and management in our setting.

Drug consumption and additional risk factors associated with microscopic colitis: Case-control study.

BACKGROUND: Microscopic colitis has now emerged as a common cause of chronic diarrhoea, but its aetiology remains unknown. Some studies suggest that commonly prescribed drugs and other additional risk factors may be triggers. AIMS: To evaluate the effects of drug intake and other risk factors on microscopic colitis patients. METHODS: A prospective, case-control study with all consecutive adult patients referred to the Hospital General de Tomelloso (Ciudad Real, Spain) for chronic watery diarrhoea (from 2008 to 2011) was performed. Microscopic colitis was diagnosed following the commonly accepted histopathological criteria. RESULTS: 46 consecutive new cases of microscopic colitis and 317 chronic diarrhoea controls were recruited. Five independent risk factors significantly associated with microscopic colitis were identified: Abdominal pain (OR 3.25; 95%CI, 1.49-7.08), weight loss (OR 2.67; 95%CI, 1.16-6.15), celiac disease (OR 15.3; 95%CI, 3.70-63.5), topiramate intake (OR 13.6; 95%CI, 1.84- 100.8), and older age at diagnosis (OR 1 year increase 1.022; 95%CI, 1.002-1.042). Use of non-steroidal anti-inflammatory drugs was associated with microscopic colitis in the subgroup of patients who fulfilled irritable bowel syndrome criteria (38.5% vs. 10.8%; p < 0.017). CONCLUSIONS: Microscopic colitis is associated with autoimmune disease, an increased age at diagnosis, topiramate intake and only in a sub-group of irritable bowel disease patients with non-steroidal anti-inflammatory drugs.

Association between medication and intestinal intussusception in children: a case-crossover study.

OBJECTIVES: This study aimed to assess the association between the appearance of intussusception in children and medication intake in the immediately preceding period (2-15 days). METHODS: A case-crossover design was used. We selected cases of children admitted with a diagnosis of intussusception (International Classification of Diseases, Ninth Revision, 860) to the major hospitals in the city of Valencia, Spain, from 2006 to 2009. We then estimated the association between the episode of intussusception and the intake of prescription medication during the preceding 2, 7, and 15 days (case period) and for the same time window 1, 2, 3, and 4 months prior (control period). Data on previous drug administration were obtained from the Pharmaceutical Service Manager System. RESULTS: A total of 95 cases (65.3% boys and 34.7% girls) were selected; 76.6% were younger than the age of 2 years. The association between intussusception and prior drug use varied depending on the exposure window: 15-day odds ratio (OR), 1.45 (95% confidence interval [95% CI], 0.86-2.43); 7-day OR, 1.46 (95% CI, 0.80-2.67); and 2-day OR, 2.26 (95% CI, 1.10-4.64). These associations were greater for children aged younger than 2 years and were usually due to the recent administration (preceding 2 days) of antibiotics (OR, 8.00; 95% CI, 1.47-43.7). CONCLUSIONS: Intussusception was more common among boys aged younger than 2 years. A positive and significant association was observed when drugs were administered 2 to 7 days before the onset of symptoms in children younger than the age of 2 years.

Reference ranges for the pulsatility index of the fetal aortic isthmus in singleton and twin pregnancies.

OBJECTIVES: The purpose of this study was to estimate reference ranges for the pulsatility index (PI) of the fetal aortic isthmus in uncomplicated singleton and twin pregnancies during the second half of pregnancy. METHODS: We conducted a cross-sectional observational study involving 543 healthy fetuses: 361 singleton pregnancies and 182 twin pregnancies between 19 and 36 weeks' gestation. The aortic isthmus PI was measured in 2 sonographic planes: the longitudinal aortic arch view and the 3-vessel and trachea view. We evaluated the reproducibility of aortic isthmus PI measurements between these planes by calculating intraclass correlation coefficients and limits of agreement. Scans were performed by 2 physicians, and intraobserver agreement was also measured. Regression analysis was used to estimate gestational age reference values for the aortic isthmus PI. RESULTS: The aortic isthmus PI was significantly correlated with gestational age in singletons and twins during the second half of pregnancy (P < .01). We did not find significant differences between reference ranges in singletons and twins or between the sonographic views. CONCLUSIONS: This study offers reference ranges for the aortic isthmus PI during the second half of gestation in singleton and twin pregnancies. Mean aortic isthmus PI values were similar in both types of gestations as well as both sonographic views. The aortic isthmus PI may be reliably obtained from either sonographic view.

Short-term relationship between hip fracture and weather conditions in two Spanish health areas with different climates.

OBJECTIVE: To evaluate differences in the short-term relationship between weather conditions and the incidence of hip fracture in people aged 65 and over among two regions of Spain. METHODS: Hip fracture incidence was calculated for the years 2000-2008 for residents of Health Area 14 in Valencian Community (Mediterranean climate) and the "Mancha Centro" Health Area in Castilla-La Mancha (inland climate), Spain. The relationship between hip fracture incidence and weather was analyzed with a case-crossover design and explored in subgroups defined by sex, age, and fracture type. RESULTS: In the inland area, a positive and significant tendency for hip fracture incidence was observed (annual increase: 1.5%) whereas in the Mediterranean area a seasonal increase of 9% was noted in autumn and winter with respect to spring. Weather conditions, especially wind, were significantly associated with hip fracture incidence: days with more frequent windy periods and/or a greater wind velocity were associated with an increase in hip fracture incidence of 51% in the Mediterranean area and 44% in the inland area. CONCLUSIONS: Hip fracture incidence exhibits seasonal changes that differ between the Mediterranean and inland areas. The short-term relationship with climate, although similar in both areas, may partly explain these seasonal changes.

Association between nutritional screening via the Controlling Nutritional Status index and bone mineral density in chronic liver disease of various etiologies.

AIM: Bone density disorders are prevalent in patients with chronic liver disease (CLD), who commonly present with hepatic osteodystrophy. However, the relationship between nutritional status and bone mineral density (BMD) has been scarcely studied in CLD. METHODS: This single-center, cross-sectional study included outpatients consecutively diagnosed with CLD during a 1.5-year period. The nutritional status was assessed with the Controlling Nutritional Status (CONUT) index; dual-energy X-ray absorptiometry scans and parameters of bone mineral metabolism were carried out. Bone fracture risk was estimated with the World Health Organization FRAX tool. RESULTS: Among the 126 patients recruited (58.7% male), osteopenia and osteoporosis were present in 31.1% and 10.7%, respectively. The 10-year fracture risk was significantly higher among women. Malnutrition estimated with the CONUT index was present in 29.9% of patients and was significantly more frequent in cirrhotic patients, 63.4% of whom were malnourished. Malnutrition stage directly correlated with hepatic function as expressed by the Model for End-Stage Liver Disease index. A non-significant relationship between CONUT-assessed nutritional status and BMD was documented. 25-Hydroxyvitamin-D3 (25[OH]-D3) and fracture risk correlated positively with the CONUT stage, and total cholesterol had an inverse relationship with BMD. CONCLUSION: Malnutrition assessed by the CONUT was very frequent in patients with liver cirrhosis. The CONUT score inversely correlated with liver function, while malnutrition stage directly correlated with BMD, fracture risk and 25(OH)-D3. Total cholesterol showed a negative association with BMD in this population.

Seroprevalence survey of zoonoses in Extremadura, southwestern Spain, 2002-2003.

Our aims were to determine the seroprevalence rates for the most common types of zoonosis among the population of Extremadura (southwestern Spain) and to identify the associated risk factors. We conducted a seroepidemiological survey to collect information on family background and the habits of people residing in Extremadura between 2002 and 2003. Antibodies to Brucella were determined by Rose Bengal staining and a standard tube agglutination test; a titer of 1/80 was considered to be positive. Antibody titers for spotted fever, leishmaniasis, echinococcosis, and toxoplasmosis were determined by enzyme-immunoassays. Independent risk factors identified were age (younger age for brucellosis), male gender (brucellosis, spotted fever, and toxoplasmosis), occupation and contact with animals (brucellosis and spotted fever for those in contact with goats, hydatidosis for those in contact with sheep, leishmaniasis for those in contact with dogs, and toxoplasmosis for those in contact with cats and pigs), and consuming contaminated food (brucellosis by eating fresh cheese, hydatidosis by eating homemade sausages, and toxoplasmosis by eating pork). Except for leishmaniasis, the other zoonoses were more prevalent in rural areas, and, with the exception of brucellosis, they were all more prevalent in Badajoz. The distribution of zoonoses in Extremadura was strongly influenced by keeping livestock and eating habits. Thus, brucellosis was more prevalent in Caceres (associated with cheese consumption), while toxoplasmosis (pork consumption) and spotted fever (from hunting) were more common in Badajoz.

Systematic review of the association between climate and hip fractures.

This study aims to systematically review epidemiological studies that evaluate the relationship between meteorology and the incidence of hip fracture (HF). After a search in Scopus, PubMed, and Embase, two independent authors assessed the relevance of studies and extracted data for description. From each study, we extracted the geographic and temporal scope, design, study variables (meteorological and related to HF), statistical analysis, and estimated associations. Of a total of 134 works, 20 studies were selected. All use an ecological design but one case-crossover. Most studies have been conducted in northern latitudes. The analysis methodology did not take into account the temporal structure of the data in 10 studies (regression and linear correlations); the rest used Poisson regression (7) and ARIMA model (3). Most studies showed significant positive associations with rainfall, especially in the form of snow: HF relative risk (RR) on days with precipitation vs. days without precipitation that ranged from 1.14 (95 % confidence interval (CI)1.04 to 1.24) to 1.60 (95 % CI 1.06 to 2.41), the temperature, with RR by one degree Celsius decline from 1.012 (95 % CI 1.004 to 1.020) to 1.030 (95 % CI 1.023 to 1.037), and wind (3) RR FC windiest days vs. calm days: 1.32 (95 % CI 1.10 to 1.58) to 1.35 (95 % CI 0.88 to 2.08). This review shows that analytic methods are very heterogeneous and poorly adapted to the temporary nature of the data. Studies confirm a certain seasonality, with more fractures in winter and meaningful relationships with meteorological conditions typical of this season.

[Trend in the susceptibility of the most frequent bacterial pathogens isolated at Hospital General La Mancha Centro over 2010-2012 period]. / Tendencia de sensibilidad de los patógenos bacterianos más frecuentemente aislados en el Hospital General La Mancha Centro durante el periodo 2010-2012.

Introduction. Our objective was to determine the trend of the antimicrobial susceptibility of the most common bacterial pathogens isolated in La Mancha Centro Hospital (MCH) between 2010-2012. Material and methods. Isolates of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa from patients admitted to MCH were studied. These data and their antibiotic susceptibility were obtained from the database OBSERVA (BioMérieux). Results. The percentages of susceptibility for S. aureus were: 50% methicillin-resistant-S. aureus (MRSA) (higher co-resistance to erythromycin and levofloxacin), 46% erythromycin, 73% clindamycin, 45% levofloxacin, 99% rifampin and 100% cotrimoxazole, glycopeptides, linezolid and daptomycin. Increased resistance in ICU was observed (63% MRSA), with 50% of S. aureus (susceptible and methicillin-resistant strains) with vancomycin MIC values ≥ 0.5 mg/L. E. coli susceptibility: 62% amoxicillin-clavulanate, 55% ciprofloxacin, 60% cotrimoxazole, 84% gentamicin and 95% fosfomycin. K. pneumoniae susceptibility: 74% amoxicillin-clavulanate, 71% ciprofloxacin, 78% cotrimoxazole, 94% gentamicin and 87% fosfomycin. The percentage of BLEE strains was 17% and 21% for E. coli and K. pneumoniae, respectively, without detection of resistance to carbapenems. P. aeruginosa susceptibility: 80% ceftazidime and carbapenems, 63% ciprofloxacin and higher than 90% aminoglycosides. A decreasing trend of susceptibility to ceftazidime and carbapenems was observed in ICU and increasing trend to ciprofloxacin. Conclusions. Resistance percentages were higher in ICU than in the rest of the hospital, highlighting 63% of MRSA strains. Our percentage of BLEE and MRSA strains were higher than the Spanish media. Rifampicin and cotrimoxazole maintain good susceptibility to S. aureus, fosfomycin and aminoglycosides to Enterobacteriaceae and carbapenems to P. aeruginosa.

Impact of changes in antibiotic prophylaxis on postoperative endophthalmitis in a Spanish hospital.

OBJECTIVE: This study aims to assess whether changes in antibiotic prophylaxis used in cataract surgery in the La Mancha Centro General Hospital, Spain, were associated with a reduced incidence of postoperative endophthalmitis (POE). METHODS: The hospital employed two different antibiotic prophylaxis regimens during two clearly differentiated periods. In the first period (January 2000 to April 2003), subconjunctival injections of gentamicin were used while in the second (May 2003 to December 2008), vancomycin and gentamicin were added to the irrigating solution. During both periods, povidone iodine was used at the site of surgery and aminoglycoside eye drops were administered postoperatively. A Poisson regression model was used to evaluate the relationship between the incidence rate of endophthalmitis and variables such as time trends, seasonality, and change in antibiotic prophylaxis regimen. RESULTS: During the period between 2000 and 2008, 26 cases of POE were detected after 14,285 operations for an incidence rate (IR) of 1.8 cases per 1000 procedures (95% confidence interval 1.2-2.7 cases out of 1000 procedures). In the period prior to the change in prophylaxis, 23 cases were detected (IR 4.5 cases/1000 procedures) while only three cases were observed in the period after the change (IR 0.3 cases/1000 procedures). A total of 84% of the microorganisms isolated were gram-positive, and all were sensitive to vancomycin. CONCLUSIONS: The change in antibiotic prophylaxis regimen for cataract surgery was associated with a relevant and significant decrease in the incidence of POE.

Real-time continuous glucose monitoring or continuous subcutaneous insulin infusion, what goes first?: results of a pilot study.

BACKGROUND: Dual devices allow both continuous subcutaneous insulin infusion (CSII) and real-time (RT) continuous glucose monitoring (CGM). Patients usually start with CSII, adding RT-CGM later (CGM post-CSII). Lack of use of RT-CGM is the main limiting factor of dual device results. Initiating RT-CGM before CSII (CGM pre-CSII) could increase RT-CGM frequency use and further improve glycemic control. SUBJECTS AND METHODS: In this 26-week pilot study, we randomly assigned, via sealed envelopes, 16 CSII and RT-CGM to naive patients 14 years of age or older with type 1 diabetes mellitus (T1DM) to CGM post-CSII or CGM pre-CSII. The Paradigm® Veo™ (Medtronic Inc., Northridge, CA) was the dual device used in all patients. The primary end point was frequency of use of RT-CGM between both groups at week 26. RESULTS: We detected a significant higher RT-CGM frequency use in the CGM pre-CSII group at week 26 (78.4±10.9% vs. 56.0±40.8%; P=0.01), although we did not detect hemoglobin A1c level differences. In addition, CGM pre-CSII patients presented less time in hypoglycemia (average daily area under curve <70 mg/dL per 24 h, 0.87±1.02 mg/dL/day vs. 3.32±2.19 mg/dL/day; P=0.021), and no severe hypoglycemia events were detected during 26 weeks in this group. CONCLUSIONS: CGM pre-CSII is effective in increasing RT-CGM frequency use in T1DM patients. This is accompanied by a significant reduction in time in hypoglycemia.