RESUMEN
BACKGROUND: Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI) rates in patients who underwent TKA after BS compared to obese patients without BS. METHODS: Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using a meta-analytical approach. RESULTS: The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p < 0.0001), with a lower risk in the BS group (z = -10.3114, p < 0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p = 0.4975). CONCLUSIONS: The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cirugía Bariátrica , Obesidad , Infecciones Relacionadas con Prótesis , Humanos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Cirugía Bariátrica/efectos adversos , Infecciones Relacionadas con Prótesis/prevención & control , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Obesidad/cirugía , Obesidad/complicaciones , Obesidad/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Factores de Riesgo , Osteoartritis de la Rodilla/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Population-based surveys on the quality of life of people with Down syndrome (DS) are difficult to perform because of ethical and legal policies regarding privacy and confidential information, but they are essential for service planning. Little is known about the sample size and variability of quality of life of people with DS living in the city of Rome, which has a population of 2.7 million inhabitants. The aim of the present study is to explore the needs and challenges in health, social integration and daily life, of people with DS living in Rome. METHODOLOGY: A cross-sectional, census-based survey was conducted in 2006. All family doctors (3016 in total) of the National Health Service were involved by the Statistical Bureau of the Municipality of Rome. As per the census, every resident citizen is registered with a family doctor and every person with disabilities is coded. Associations for Down Syndrome encouraged their members to participate in the research. Questionnaires were completed by families of people with DS, in accordance with privacy laws. FINDINGS: An initial survey, conducted via a letter and a telephone contact with family doctors, identified 884 people with DS residing in the city of Rome. Data on the medical and social conditions of 518 people with DS, ranging in age from 0 to 64 years, were collected. Some 88% of these were living with their original family; 82.1% had one or more siblings, and 19.5% had lost one or both parents. A full 100% of children with DS were enrolled in the public school system. This ensures that they are fully occupied and entirely integrated in society. After secondary school there is a lack of opportunities. Thus, only 10% of adults were working with a regular contract. A mere 42.2% of people with DS aged 25-30 were involved in some form of regular activity (although not always on a daily basis). After the age of 30, the percentage of people demonstrating decline in function increased sharply, while disability-related support decreased. In other words, as people with DS age, daily life evolves increasingly around the home, with only occasional outdoor activities. CONCLUSION: The health, employment and social needs of the majority of people with DS in the city of Rome are not being met. The findings of this study underscore the urgent need for more comprehensive inclusion in society of adults with DS and for the provision of support services to create an enabling environment for inclusion. Because of the variability of performance among individuals with DS, there is a need to create more case-specific options in terms of work, living arrangements, social networking and medical services. Schooling and social inclusion in childhood alone do not guarantee a satisfactory quality of life in adulthood. It is argued herewith that policy of inclusion and support should extend over the entire lifetime of people with DS.
Asunto(s)
Actividades Cotidianas/psicología , Síndrome de Down/psicología , Síndrome de Down/rehabilitación , Evaluación de Necesidades/estadística & datos numéricos , Calidad de Vida/psicología , Adolescente , Adulto , Distribución por Edad , Cuidadores/estadística & datos numéricos , Niño , Preescolar , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Estudios Transversales , Educación de las Personas con Discapacidad Intelectual/estadística & datos numéricos , Empleos Subvencionados/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Discapacidad Intelectual/psicología , Discapacidad Intelectual/rehabilitación , Masculino , Persona de Mediana Edad , Ciudad de Roma , Distribución por Sexo , Apoyo Social , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Fas (CD95) triggers programmed cell death and is involved in cell-mediated cytotoxicity and in shutting off the immune response. Inherited loss-of-function mutations hitting the Fas system cause the autoimmune/lymphoproliferative syndrome (ALPS). We have recently shown that ALPS patients' families display increased frequency of common autoimmune diseases, including type 1 diabetes. This work evaluates Fas function in type 1 diabetic patients without typical ALPS. Cell death induced by anti-Fas monoclonal antibody was investigated in T-cells from 13 patients with type 1 diabetes alone and 19 patients with type 1 diabetes plus other autoimmune diseases (IDDM-P). Moreover, we analyzed 19 patients with thyroiditis alone (TYR), because most IDDM-P patients displayed thyroiditis. Frequency of resistance to Fas-induced cell death was significantly higher in patients with IDDM-P (73%) than in type 1 diabetic (23%) or TYR (16%) patients or in normal control subjects (3%). The defect was specific because resistance to methyl-prednisolone-induced cell death was not significantly increased in any group. Fas was always expressed at normal levels, and no Fas mutations were detected in four Fas-resistant IDDM-P patients. Analysis of the families of two Fas-resistant patients showing that several members were Fas-resistant suggests that the defect has a genetic component. Moreover, somatic fusion of T-cells from Fas-resistant subjects and the Fas-sensitive HUT78 cell line generates Fas-resistant hybrid cells, which suggests that the Fas resistance is due to molecules exerting a dominant-negative effect on a normal Fas system. These data suggest that Fas defects may be a genetic factor involved in the development of polyreactive type 1 diabetes.
Asunto(s)
Enfermedades Autoinmunes/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/fisiopatología , Receptor fas/fisiología , Adolescente , Adulto , Anticuerpos Monoclonales/farmacología , Muerte Celular/efectos de los fármacos , Muerte Celular/fisiología , Línea Celular , Niño , Diabetes Mellitus Tipo 1/genética , Resistencia a Medicamentos , Femenino , Humanos , Masculino , Mutación , Valores de Referencia , Linfocitos T/inmunología , Linfocitos T/fisiología , Tiroiditis/fisiopatología , Receptor fas/análisis , Receptor fas/genética , Receptor fas/inmunologíaRESUMEN
The Wiskott-Aldrich syndrome (WAS) is a X-linked hematologic disorder characterized by thrombocytopenia, eczema, and immunodeficiency of variable severity. Reported here are the results of a morphologic, morphometric, and immunophenotypic analysis of splenic lymphoid tissue in 12 WAS patients with documented molecular defect and with different disease severity. Spleens from 29 age-matched patients with different diseases were used as controls. Paraffin-embedded tissue (from all cases) and fresh-frozen samples (from 5 WAS patients and 4 control subjects) were used to study the different white pulp compartments by classic morphologic, immunophenotyping, and image analysis techniques. Data were statistically analyzed by both parametric and nonparametric tests. Spleens from WAS patients showed a significant depletion of the total white pulp (p = 0.0008), T cell (p < 0.05), and B cell (p = 0.0002) areas and marginal zone (MZ) thickness (p < 0.0001). Among WAS patients, a negative correlation was found between the score of severity of the disease and all variables considered (Spearman's rank correlation coefficient, r = -0.79, r = -0.73, r = -0.68, and r = -0.56, respectively). In conclusion, this study shows that in WAS a general depletion of the splenic white pulp occurs, supporting the evidence that WAS is characterized by a combined immune defect. The significant reduction of the MZ may explain the inability of WAS patients to mount a response to T-independent antigens.
Asunto(s)
Enfermedades del Bazo/patología , Síndrome de Wiskott-Aldrich/patología , Antígenos CD/análisis , Linfocitos B/inmunología , Niño , Preescolar , Análisis Mutacional de ADN , Humanos , Procesamiento de Imagen Asistido por Computador , Inmunofenotipificación , Lactante , Mutación , Reacción en Cadena de la Polimerasa , Proteínas/genética , Enfermedades del Bazo/genética , Enfermedades del Bazo/inmunología , Enfermedades del Bazo/cirugía , Linfocitos T/inmunología , Síndrome de Wiskott-Aldrich/genética , Síndrome de Wiskott-Aldrich/inmunología , Síndrome de Wiskott-Aldrich/cirugía , Proteína del Síndrome de Wiskott-AldrichRESUMEN
A total of 3879 samples of foodstuffs were examined for the presence of Verocytotoxin-producing Escherichia coli O157 (VTEC O157). The survey was conducted by 9 of the 10 Italian Veterinary Public Health Laboratories. Samples were collected between May 2000 and September 2001 in 14 regions and comprised 931 minced beef specimens and 2948 dairy products (DP) with less than 60 days of ripening. The DP included 657 pasteurised and 811 unpasteurised bovine DP, 477 pasteurised and 502 unpasteurised ovine DP, and 501 water-buffalo's milk mozzarella cheese. Samples were collected at retail level, from plants processing minced beef and dairy plants and from farms directly manufacturing cheeses. All the samples were tested using a sensitive procedure based on ISO/DIS 16654:1999 (later ISO 16654:2001), which includes an immunomagnetic separation step. A preliminary inter-laboratory trial was organised with artificially contaminated samples to assess the ability of all the participating laboratories to isolate E. coli O157 by the established procedure. VTEC O157 was isolated from four (0.43%) of the minced beef samples, collected in four different regions and during different months, but was not detected in any of the dairy products. E. coli O157 VT-eae+ was isolated from one raw cow's milk cheese. This survey provided national data on the presence of VTEC O157 in foodstuffs, demonstrating a low prevalence of the organism. The survey also encouraged updating of knowledge and procedures on VTEC O157 in laboratories with official responsibility for microbiological testing of foods of animal origin.
Asunto(s)
Productos Lácteos/microbiología , Escherichia coli O157/aislamiento & purificación , Contaminación de Alimentos/análisis , Laboratorios/normas , Productos de la Carne/microbiología , Animales , Recuento de Colonia Microbiana/instrumentación , Recuento de Colonia Microbiana/métodos , Seguridad de Productos para el Consumidor , Escherichia coli O157/metabolismo , Microbiología de Alimentos , Humanos , Italia , Prevalencia , Salud Pública , Toxinas Shiga/biosíntesisRESUMEN
AIMS: Multicentre evaluation of biochemical and molecular methods for the identification of Vibrio parahaemolyticus. METHODS AND RESULTS: For the biochemical identification methods, API 20E and API 20NE and Alsina's scheme were evaluated in intra- and interlaboratory tests in order to determine the accuracy and concordance of each method. Both in intra- and interlaboratory tests, the Alsina's scheme showed the highest sensitivity (86% of correct identifications in the interlaboratory test). False-positive results were obtained by all methods (specificity was 95% for API 20E, 73% for API 20NE and 84% for Alsina's scheme) and concordance varied from 65% of API 20NE to 84% of API 20E. For the molecular identifications, polymerase chain reaction (PCR) for the detection of toxR gene, tl gene and pR72H fragment were tested on 30 strains by two laboratories. The PCR for toxR showed the highest inclusivity (96%), exclusivity (100%) and concordance (97%). CONCLUSIONS: Among the biochemical identification methods tested, the Alsina's scheme gave more reliable results; however, in order to avoid false-positive results, all the biochemical identifications should be confirmed by means of molecular methods. SIGNIFICANCE AND IMPACT OF THE STUDY: Availability of an efficient identification method of Vibrio parahaemolyticus to use in official control of fisheries products.
Asunto(s)
Vibrio parahaemolyticus/aislamiento & purificación , Proteínas Bacterianas/genética , Técnicas Bacteriológicas/métodos , ADN Bacteriano/genética , Proteínas de Unión al ADN/genética , Reacciones Falso Positivas , Genes Bacterianos/genética , Reacción en Cadena de la Polimerasa/métodos , Factores de Transcripción/genética , Vibrio parahaemolyticus/genética , Vibrio parahaemolyticus/metabolismoAsunto(s)
Antieméticos/uso terapéutico , Trasplante de Médula Ósea/efectos adversos , Isoquinolinas/uso terapéutico , Náusea/prevención & control , Quinuclidinas/uso terapéutico , Vómitos/prevención & control , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Náusea/etiología , Neoplasias/cirugía , Palonosetrón , Estudios Retrospectivos , Antagonistas de la Serotonina/uso terapéutico , Vómitos/etiologíaRESUMEN
The efficacy of immunosuppressive treatment was evaluated in a group of 15 children (aged 2-10 years) affected by clinically asymptomatic, biochemically mild, HBSAg-positive, delta-antibody-negative, histologically moderate, chronic active hepatitis (CAH). Clinical, biochemical, serological, and histological features of chronic hepatitis B virus (HBV) infection were studied during a follow-up of 2 years. Eight of 15 patients received immunosuppressive treatment (prednisone plus azathioprine); seven received a placebo. No significant differences were found among treated and untreated patients, an overall improvement of nearly all parameters of disease (aminotransferases, albumin, prothrombin time, immunoglobulins, bromsulphalein at 45 min, and bile acid serum levels) being found in both groups. Treated patients showed an improvement in aminotransferase levels only at the first 3-month checkup. This finding, however, was not statistically significant in our study and disappeared at subsequent follow-up examinations. A high incidence of HBeAg was noted at entry into the study (10 of 15 patients checked). HBeAg seroconversion was observed in two of the six HBeAg-positive treated patients and in two of the four HBeAg-positive untreated patients. Finally, the histological picture showed similar patterns in both groups of patients studied. Our data suggest that no benefit from immunosuppressive therapy can be proven at this time in asymptomatic, moderately active, HBsAg-positive, delta-negative CAH in children.