Preoperative intragastric balloon in morbid obesity is unable to decrease early postoperative morbidity of bariatric surgery (sleeve gastrectomy and gastric bypass): a clinical assay.

INTRODUCTION: There are few studies that investigate the usefulness of the preoperative intragastric balloon (IGB). This study will evaluate if pre-surgical weight loss with IGB reduces morbidity and mortality after surgery. METHOD: Prospective randomised study of patients with morbid obesity treated with gastric bypass or vertical gastrectomy, with two arms: the balloon arm (B-arm), where an IGB was inserted within the 6 months before surgery, and the control arm (C-arm). RESULTS: The study included 66 patients: 65.6% women, 69.6% with bypass. Age: 43 years (SD 10.2) B-arm and 42.6 years (SD 9.2) in the C-arm. We found 34.4% therapeutic failures in IGB. The mean body weight loss, %EWL and BMI reduction before surgery was 16.2 kg (SD 9.84) B-arm versus 4.7 (SD 8.70) in the C-arm, 23.6% versus 4.7% (p < 0.001) and 6.04 versus 1 (p < 0.001), respectively. The hospital stay was 7 days (p25-75: 5-8) B-arm and 7 days (p25-75: 5-9) in the C-arm (p = 0.937). Post-surgical morbidity with IGB was 25% versus 29.5% in the C-arm, p = 0.689. The number needed to treat (NNT) to prevent of post-surgical morbidity was 23 patients. The B-arm presented 54.5% moderate-severe post-surgical adverse events (12.5%) versus 82.6% in the C-arm (23.5%), p = 0.111. The cost of placing a balloon was more than 4000 Euros each. CONCLUSIONS: The preoperative balloon does not achieve a reduction in the post-surgical morbidity, nor does it reduce the hospital stay or rate of re-operations. The balloon achieves a higher weight loss result when compared to a diet programme, its added cost must also be given due consideration. TRAIL REGISTRY: This study has been registered on ClinicalTrials.gov with the Identifier: NCT01998243 (November 28, 2013).

Clinical outcome and prognostic factors of revision arthroscopic rotator cuff tear repair.

PURPOSE: The aim of this study was to evaluate the clinical outcome of arthroscopic rotator cuff revision surgery in a cohort of patients and to identify prognostic factors for this procedure. METHODS: Fifty-one consecutive patients undergoing revision arthroscopic rotator cuff repair were prospectively followed over a minimum period of one year. Radiologic findings and clinical data regarding primary and revision surgery were collected. Clinical evaluation was performed pre- and post-operatively by means of Constant Score and Simple Shoulder Test. RESULTS: Median age at the time of revision surgery was 60 years (range 36-77 years). Median follow-up was 25 months (range 12-58 months). There were 17 men (33.3%) and 34 women (66.7%). The majority of the tears affected the supraspinatus tendon alone (51%) or both the supra- and infraspinatus tendons (35.3%). Significant improvements were seen in terms of active forward elevation, active external rotation, pain, Simple Shoulder Test score, Constant Score, and post-operative satisfaction-age, gender, and time to revision surgery did not show significant predictive value. A smaller tear size and pre-operative elevation greater than 90° were demonstrated to be independent prognostic factors for better outcome. However, the mean increase in Constant Score was not related to the size of the tear, range of motion, or age. CONCLUSION: The results of this study indicate that arthroscopic revision rotator cuff repair results in reliable improvement in shoulder function, pain, and satisfaction. Pre-operative active range of motion and tear size seem to determine final outcome. A similar increase in mean Constant Score can be achieved even in large tears in patients aged over 65 years. LEVEL OF EVIDENCE: IV.

[Hepatitis B virus reactivation in rituximab-treated patients: incidence and risk factors]. / Reactivación del virus de la hepatitis B en pacientes tratados con rituximab: incidencia y factores de riesgo.

Hepatitis B virus (HBV) reactivation after chemotherapy regimens is a well-known complication. The incidence and risk factors for HBV reactivation remain to be elucidated. We aimed to determine the incidence and risk factors for HBV reactivation in patients receiving rituximab, and the potential role of the cumulative rituximab dose in HBV reactivation. We retrospectively reviewed 320 patients receiving rituximab in our hospital. Of these, 42 (13.12%) had serological markers of hepatitis B. During follow-up, 21% (9/42) had HBV reactivation. Risk factors for reactivation were HBsAg positivity (p < 0.05), isolated anti-HBc positivity (p < 0.05), marginal zone lymphoma, and Mantle cell lymphoma (p < 0.05). The median rituximab dose tended to be higher in patients with reactivation (p = 0.06).

Fundoplication with extensive dissection of the esophagogastric junction: Lessons learned and outcomes from 178 consecutives patients.

INTRODUCTION: Antireflux surgery is commonly associated with significant recurrence and complication rates, and several surgical techniques have been proposed to minimize them. The aim of this study is to evaluate the results of a fundoplication with extensive dissection of the esophagogastric junction 1 and 3 years after the procedure. METHODS: Retrospective observational study including 178 patients with gastroesophageal reflux disease or hiatal hernia who underwent fundoplication with extensive dissection of the esophagogastric junction between 2015 and 2020. Hernia recurrence, symptoms and quality of life at 1 and 3 years after surgery were assessed by barium transit, endoscopy and questionnaires for symptoms and quality of life (GERD-HRQL). RESULTS: Heartburn rate was 7.5% and 10.7% at 1 and 3 years respectively, regurgitation 3.8% and 6.9% and dysphagia was 3.7% and 7.6%. The presence of hiatal hernia was evident preoperatively in 55.1% and in 7.8% and 9.6% at follow-up and the median GERD-HRQL scale was 27, 2 and 0 respectively. There were no cases of slippage of the fundoplication or symptoms suggestive of vagal injury. No differences were found when comparing the different types of fundoplication in terms of reflux and recurrence or complications. CONCLUSIONS: Fundoplication with extensive dissection of the esophagogastric junction contributes to correct positioning and better anchorage of the fundoplication, which is associated with low rates of hiatal hernia and reflux recurrence, as well as absence of slippage and lower possibility of vagal injury.

Anatomical and functional impairment of the nerve fiber layer in patients with optic nerve head drusen.

OBJECTIVE: To evaluate anatomical and functional impairment of the retinal nerve fiber layer (RNFL) using optical coherence tomography (OCT) and automated perimetry in patients with optic nerve head drusen (ONHD). MATERIALS AND METHODS: Sixty-six eyes (66 patients) were studied with ONHD - confirmed by ultrasound B scan - and 70 eyes (70 subjects) of healthy control subjects. ONHD cases were categorised as visible or hidden. Average RNFL thickness and measurements in terms of the quadrants were analysed using both time-domain optical coherence tomography (TD-OCT) and spectral-domain optical coherence tomography (SD-OCT). Anatomical and visual field alteration of RNFL between visible and hidden ONHD and control groups were compared. RESULTS: Average RNFL thickness in ONHD patients was 94 µm (TD-OCT) and 88 µm (SD-OCT), and in controls 107 µm (TD-OCT) and 96 µm (SD-OCT), with statistically significant differences between both OCTs. All quadrants analysed showed significant differences except the temporal quadrant. The differences were not significant between hidden drusen and controls.Visual field examination in ONHD showed alterations in 56 %. Alterations were greater in visible drusen in relation to non-visible drusen, but there were no significant differences.The association between RNFL defects in superior, inferior and temporal quadrants and visual field defects showed a statistical relation with visible ONHD, but not in hidden ONHD. CONCLUSIONS: ONHD caused anatomical and functional damage of the RNFL, with a clear association between the alteration in ONHD and visual field defects in visible drusen cases.

Sensitivity and specificity of monochromatic photography of the ocular fundus in differentiating optic nerve head drusen and optic disc oedema: optic disc drusen and oedema.

BACKGROUND: Evaluation of the efficacy of monochromatic photography of the ocular fundus in differentiating optic nerve head drusen (ONHD) and optic disc oedema (ODE). METHODS: Sixty-six patients with ONHD, 31 patients with ODE and 70 healthy subjects were studied. Colour and monochromatic fundus photography with different filters (green, red and autofluorescence) were performed. The results were analysed blindly by two observers. The sensitivity, specificity and interobserver agreement (k) of each test were assessed. RESULTS: Colour photography offers 65.5 % sensitivity and 100 % specificity for the diagnosis of ONHD. Monochromatic photography improves sensitivity and specificity and provides similar results: green filter (71.20 % sensitivity, 96.70 % specificity), red filter (80.30 % sensitivity, 96.80 % specificity), and autofluorescence technique (87.8 % sensitivity, 100 % specificity). The interobserver agreement was good with all techniques used: autofluorescence (k = 0.957), green filter (k = 0.897), red filter (k = 0.818) and colour (k = 0.809). CONCLUSIONS: Monochromatic fundus photography permits ONHD and ODE to be differentiated, with good sensitivity and very high specificity. The best results were obtained with autofluorescence and red filter study.

Comparison of optic area measurement using fundus photography and optical coherence tomography between optic nerve head drusen and control subjects.

PURPOSE: To compare optic disc area measurement between optic nerve head drusen (ONHD) and control subjects using fundus photography, time-domain optical coherence tomography (TD-OCT) and spectral-domain optical coherence tomography (SD-OCT). We also made a comparison between each of the three techniques. METHODS: We performed our study on 66 eyes (66 patients) with ONHD and 70 healthy control subjects (70 controls) with colour ocular fundus photography at 20º (Zeiss FF 450 IR plus), TD-OCT (Stratus OCT) with the Fast Optic Disc protocol and SD-OCT (Cirrus OCT) with the Optic Disc Cube 200 × 200 protocol for measurement of the optic disc area. The measurements were made by two observers and in each measurement a correction of the image magnification factor was performed. Measurement comparison using the Student's t-test/Mann-Whitney U test, the intraclass correlation coefficient, Pearson/Spearman rank correlation coefficient and the Bland-Altman plot was performed in the statistical analysis. RESULTS: Mean and standard deviation (SD) of the optic disc area in ONHD and in controls was 2.38 (0.54) mm(2) and 2.54 (0.42) mm(2), respectively with fundus photography; 2.01 (0.56) mm(2) and 1.66 (0.37) mm(2), respectively with TD-OCT, and 2.03 (0.49) mm(2) and 1.75 (0.38) mm(2), respectively with SD-OCT. In ONHD and controls, repeatability of optic disc area measurement was excellent with fundus photography and optical coherence tomography (TD-OCT and SD-OCT), but with a low degree of agreement between both techniques. CONCLUSIONS: Optic disc area measurement is smaller in ONHD compared to healthy subjects with fundus photography, unlike time-domain and spectral-domain optical coherence tomography in which the reverse is true. Both techniques offer good repeatability, but a low degree of correlation and agreement, which means that optic disc area measurement is not interchangeable or comparable between techniques.

Using artificial intelligence to reduce orthopedic surgical site infection surveillance workload: Algorithm design, validation, and implementation in 4 Spanish hospitals.

BACKGROUND: Surgical site infection (SSI) surveillance is a labor-intensive endeavor. We present the design and validation of an algorithm for SSI detection after hip replacement surgery, and a report of its successful implementation in 4 public hospitals in Madrid, Spain. METHODS: We designed a multivariable algorithm, AI-HPRO, using natural language processing (NLP) and extreme gradient boosting to screen for SSI in patients undergoing hip replacement surgery. The development and validation cohorts included data from 19,661 health care episodes from 4 hospitals in Madrid, Spain. RESULTS: Positive microbiological cultures, the text variable "infection", and prescription of clindamycin were strong markers of SSI. Statistical analysis of the final model indicated high sensitivity (99.18%) and specificity (91.01%) with an F1-score of 0.32, AUC of 0.989, accuracy of 91.27%, and negative predictive value of 99.98%. DISCUSSION: Implementation of the AI-HPRO algorithm reduced the surveillance time from 975 person/hours to 63.5 person/hours and permitted an 88.95% reduction in the total volume of clinical records to be reviewed manually. The model presents a higher negative predictive value (99.98%) than algorithms relying on NLP alone (94%) or NLP and logistic regression (97%). CONCLUSIONS: This is the first report of an algorithm combining NLP and extreme gradient-boosting to permit accurate, real-time orthopedic SSI surveillance.

Sensitivity and specificity of time-domain and spectral-domain optical coherence tomography in differentiating optic nerve head drusen and optic disc oedema.

PURPOSE: To evaluate the efficacy of time-domain optical coherence tomography (TD-OCT) and spectral-domain optical coherence tomography (SD-OCT) in differentiating between optic nerve head drusen (ONHD) and optic disc oedema (ODE). METHODS: We studied 66 patients with ONHD, 31 patients with ODE, and 70 controls using TD-OCT and SD-OCT. We analysed two aspects of the tomographic findings: (i) quantitative, through measurement of the retinal nerve fibre layer (RNFL) and papillary elevation; and (ii) qualitative, through assessment of the hyporeflective space, morphology of the internal contour, focal papillary mass and RNFL increases in seven contiguous clock hours. We evaluated the sensitivity, specificity, intra-class correlation coefficient (ICC), and inter-observer agreement (κ). RESULTS: The quantitative analysis of the RNFL revealed an average thickness of the RNFL <124µm with TD-OCT (sensitivity=91%; specificity=94%) and <116µm with SD-OCT (sensitivity=91%; specificity=97%). The thickness of the nasal quadrant was <108µm with TD-OCT (sensitivity=89%; specificity=87%) and with SD-OCT was <92µm (sensitivity=88%; specificity=94%), however without significant differences between the nasal, superior and inferior quadrants' and average thickness. The measurement of papillary elevation was 0.85mm with TD-OCT (sensitivity=96%; specificity=84% [ICC=0.96]) and was <0.80 mm with SD-OCT (sensitivity=86%; specificity=87% [ICC=0.94]). The abrupt termination of the hyporeflective space measured with TD-OCT had sensitivity=79% and specificity=90% (κ=0.60) and with SD-OCT had sensitivity=88% and specificity=89% (κ=0.75); the irregularity of the internal contour with TD-OCT had sensitivity=80% and specificity=90% (κ=0.70) and with SD-OCT had sensitivity=88% and specificity=90% (κ=0.75); and the absence of seven contiguous clock hours had values of sensitivity=97% and specificity=77% with TD-OCT and had sensitivity=98% and specificity=77% with SD-OCT. CONCLUSIONS: Optical coherence tomography allowed for differentiation between ONHD and ODE, yielding similar results with TD-OCT and SD-OCT. The new quantitative parameters of papillary elevation and RNFL measurements showed greater sensitivity and specificity than the qualitative criteria.

Ophthalmic features of optic disc drusen.

PURPOSE: To evaluate the ophthalmoscopic manifestations of patients with visible and hidden optic disc drusen (ODD). METHOD: We studied 55 patients (100 eyes) with ODD that were confirmed using B-scan ultrasonography and a control group of 60 patients (100 eyes) for differential diagnosis. We analysed the optic nerve features with stereoscopic photography and compared the characteristics between visible and hidden ODD and between hidden ODD and papilloedema. RESULTS: The patients with ODD presented the following ophthalmoscopic features: visible drusen (52%), blurred edges (84%), raised optic disc (74%), absence of optic disc cupping (69%), absence of venous pulse (54%), abnormal vascular branching (81%), presence of cilioretinal vessels (42%), peripapillary atrophy (56%) and haemorrhages (2%). Comparison of the qualitative characteristics of the papillae of the eyes with visible and hidden ODD showed statistically significant differences in all parameters studied, except for morphological alterations (p = 0.851) and haemorrhage (p = 0.954). Comparison of hidden ODD with papilloedema showed statistically significant differences in blurred edges, disc elevation, absence of optic disc cupping, altered colour, anomalous vascular branching and optic disc haemorrhages (p < 0.005). CONCLUSIONS: Ophthalmologic features associated with ODD can help us to diagnose their presence and avoid confusing them with papilloedema.

Impact of sink removal from intensive care unit rooms on the consumption of antibiotics and on results of Zero Resistance Project.

INTRODUCTION: Due to the favourable impact of removing the sinks on isolations in bronchoaspirate samples of patients with mechanical ventilation, we now evaluate the impact on the consumption of antibiotics as well as on the results of the Zero Resistance Project (ZRP). PATIENTS AND METHODS: All the patients admitted to the unit in a quasi-experimental before-after study with a pre-intervention period between 2014 and 2016 and a post-intervention period from 2016 to 2017, to evaluate antibiotic consumption in defined daily doses, and until 2018, to evaluate the ZRP indicators. The intervention was the removal of the sinks from the rooms of the ICU. We evaluated antibiotic consumption densities and their ratios, grouped as Enterobacteriaceae and non-fermenting gram-negative bacilli (NFGNB) according to their antibiograms; the absolute number of 'antibiotic days', 'hospitalised days', 'isolation days', and 'multi-resistant bacteria (MRB) days'; as well as their incidence densities per 1000 hospitalised days and the ratio between the two years prior to and the two years after the intervention. RESULTS: Post-intervention antibiotic use was 1.61-fold (1.60-1.62) and 2.24-fold (2.10-2.37) lower for antibiotics used against Enterobacteriaceae and NFGNB, respectively. There were also reductions in the number of days of antibiotic use by 1.29-fold (1.22-1.36), number of MRB days by 1.84-fold (1.63-2.08), and number of patient isolation days by 1.51-fold (1.38-1.66). DISCUSSION: The results suggest that the intervention had a favourable impact on the consumption of antibiotics, as well as on the number of days on antibiotics, MRB, and isolation.

[Hate violence in the emergency rooms of third level hospitals. First data in Spain]. / Violencia de odio en los servicios de urgencias de hospitales de tercer nivel. Primeros datos en España.

OBJECTIVE: To describe the cases of hate violence attended in emergency services. METHOD: A cross-sectional study of a series of cases of aggression treated in the emergency rooms of two hospitals in Madrid, between April 2015 and March 2018. The cases of hate violence are described in terms of their sociodemographic, clinical-epidemiological and incident data and compared with other types of violence within the study. RESULTS: A total of 147 patients were included and 49% reported having been victims of hate violence. Among the victims, 61% were men, the average age was 36 years and 48% had a medium-high level of education. The most frequent motivations were physical appearance, nationality and ethnic origin. The place of aggression was the street in 50%, and in 61% of the cases it was perpetrated by more than one person (83% by men). The most common injury was contusion (71%) and the most frequent location the head and neck (71%). Only 8% required admission. CONCLUSIONS: The surveillance of hate violence would foster more accurate knowledge of the real magnitude and characteristics of this health problem and improve the quality of care for victims.

Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact.

OBJECTIVES: To determine (1) the incidence of surgical site infection (SSI) in patients undergoing soft tissue surgery at a veterinary teaching hospital and to study (2) and describe the main risk factors associated with SSI and (3) assess the economic impact of SSI. DESIGN: Prospective cohort study. SETTING: Veterinary teaching hospital. PARTICIPANTS: 184 dogs undergoing soft tissue surgery during a 12-month period (October 2013 to September 2014). PRIMARY OUTCOME MEASURE: Surgical site infection. RESULTS: Out of the 184 patients analysed, SSI was diagnosed in 16 (8.7 per cent) patients, 13 (81.3 per cent) were classified as superficial incisional infection, 2 (12.5 per cent) as deep incisional infection and 1 (6.3 per cent) as organ/space infection. The administration of steroidal anti-inflammatory drugs (P=0.028), preoperative hyperglycaemia (P=0.015), surgical times longer than 60 minutes (P=0.013), urinary catheterisation (P=0.037) and wrong use of the Elizabethan collar (P=0.025) were identified as risk factors. Total costs increased 74.4 per cent, with an increase in postsurgical costs of 142.2 per cent. CONCLUSIONS: The incidence of SSI was higher than the incidence reported in other published studies, although they were within expected ranges when a surveillance system was implemented. This incidence correlated with an increase in costs. Additionally new important risk factors for its development were detected.

[Interpersonal violence in Spain through national hospital discharge survey]. / La violencia interpersonal en España a través del Conjunto Mínimo Básico de Datos.

OBJECTIVE: To describe the epidemiology of interpersonal violence in Spain. METHOD: Descriptive study of the cases of patients with secondary diagnosis of aggression registered on a national hospital discharge database, between 1999 and 2011, using the codes from E960 to E969 of the ICD-9. The distribution by sex, age and type of discharge, associated morbidity, mortality and by autonomous community is described. The quality of the record is studied according to its temporal variation. RESULTS: The case profile of aggression in men (85%) is of a patient between 15 and 44 years old, who in 93.7% of cases requires urgent care and whose severity is moderate (95% discharge home). Two point five percent of patients are readmitted and death occurs in1.1%. The profile in women (15%) differs slightly, with an age between 31 and 52 years, 94% require urgent attention, although 96% have moderate severity; 3% are readmitted and 1.7% die. CONCLUSIONS: Although they need to be improved to avoid certain limitations, health information systems are a rich source of data that can be used for research in health and, through their results, for the development of prevention plans and intervention in matters of violence.

Impact of removing sinks from an intensive care unit on isolations by gram-negative non-fermenting bacilli in patients with invasive mechanical ventilation. / Impacto de la retirada de los lavabos en una unidad de cuidados intensivos sobre los aislamientos por bacilos gramnegativos no fermentadores en pacientes con ventilación mecánica invasiva.

INTRODUCTION AND OBJECTIVE: Contamination of sinks, even due to their underuse, is associated with the transmission of non-fermenting gram-negative bacilli (NFGNB) to patients in Augmented Care Units. After previous monitoring with environmental and patient samples, we now explore the impact of removing sinks from ICU cubicles on incidental isolations related to health care in bronchoaspirate samples of patients with invasive mechanical ventilation (IMV). MATERIAL AND METHODS: Quasi-experimental study, before-and-after, pre-intervention annuities April 2014-2016 and post-intervention April 2016-2017. Incidence densities per 1,000 days of IMV were studied, comparing by the exact method based on the binomial distribution and estimating the incidence density ratio. RESULTS: The incidence densities per 1,000 days of IMV of isolations by NFGNB in bronchoaspirate samples of the pre and post-intervention periods were 11.28 and 1.9, respectively. This implies a post-intervention incidence density 5.90 times lower than before (95% CI: 1.49-51.05, P=.003). CONCLUSIONS: Despite of the limitations of the design, the removal of sinks showed a reduction of the isolations.

Accuracy of tumor size measurements performed by magnetic resonance, ultrasound and mammography, and their correlation with pathological size in primary breast cancer. / Precisión de la resonancia magnética, ecografía y mamografía en la medida del tamaño tumoral y su correlación con el tamaño histopatológico en el cáncer de mama primario.

INTRODUCTION: The objective of this study was to determine which image test used to measure the size of pre-operative primary breast cancer (mammography, ultrasound or magnetic resonance imaging [MRI]) correlated best with the size of the tumor in the postoperative surgical specimen. METHODS: A retrospective analysis was conducted of women diagnosed with breast cancer for which primary surgical treatment was indicated and who underwent surgical intervention between January 2014 and December 2016. Sociodemographic, imaging and histological variables were collected. The results are presented by age group, tumor size and histological type. RESULTS: In the 224 women studied, mammography and MRI tumor sizes were compared with pathology study tumor measurements, revealing no significant differences, both overall and based on histologic type or age. However, both significantly underestimated large tumors and significantly overestimated small tumors. Ultrasound significantly underestimated tumor size, especially in large tumors, older patients and in infiltrating ductal carcinoma (IDC) and infiltrating ductal carcinoma with associated ductal carcinoma in situ (IDC+DCIS). MRI correlated best with histological tumor size, although with no statistically significant differences. CONCLUSIONS: MRI is the best predictor of tumor size in breast cancer. Histologic type and tumor size are key parameters when estimating tumor size and should be taken into account when planning surgery. Patient age does not interfere with the interpretation of imaging tests.

Under-utilization of taps in intensive care unit as a cause of reservoirs of nonfermenting gram-negative bacilli. / La infrautilización de grifos en una unidad de cuidados intensivos como causa de reservorios de bacilos gramnegativos no fermentadores.

INTRODUCTION: The under-utilisation of taps is associated with the generation of reservoirs of non-fermenting gram-negative bacilli with the ability to disseminate. We describe the detection and approach of the problem in an ICU. METHODS: Observational descriptive study in an ICU with individual cubicles with their own sink. We collected clinical samples from patients and environmental samples from tap aerators and reviewed the unit's hygiene measures. RESULTS: We detected four cases due to Chryseobacterium indologenes, one to Elizabethkingia meningoseptica and another to Pseudomonas aeruginosa; they were identified both in clinical and the environmental samples. The healthcare professionals reported that almost every hand hygiene opportunity was performed with a hydroalcoholic solution. After considered the daily flushing of water outlets as inefficient, it was decided to remove them. CONCLUSIONS: National recommendations were insufficient for preventing, detecting and controlling tap contamination in units with a high risk of infection. The management of taps in these units needs to be improved.

Human papilloma virus dermatosis in human immunodeficiency virus-positive patients: A 14-year retrospective study in 965 patients. / Dermatosis por virus de papiloma humano (VPH) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH): estudio retrospectivo de 965 pacientes durante 14 años.

INTRODUCTION: The incidence of the human papilloma virus (HPV) has not dropped in HIV-positive patients despite the discovery of antiretroviral therapy (ART). Our goal is to assess the prevalence of HPV in HIV patients and its relationship with the epidemiological and virological characteristics of HIV patients. PATIENTS AND METHODS: Retrospective cohort of 965 patients diagnosed with HIV from 1998 to 2012. We analyzed patients' demographic factors and factors related to the HPV. RESULTS: Of the 965 patients examined, 333 consulted a dermatologist. Of these, 52 patients had genital warts (15.6%), 43 had common warts (12.9%) and 8% had both conditions. In total, 28.5% of patients had a skin lesion caused by HPV. DISCUSSION AND CONCLUSION: This is the first longitudinal observational study carried out on HIV-positive patients in the era of ART in which HPV infection is the most common skin pathology. We observed a similar trend in countries with access to ART. This study spreads awareness on the importance of preventing HPV and the difficulty of treating it in HIV-positive patients.

Hip arthroscopy for the treatment of femoroacetabular impingement: a comparative study between the classic and the outside-in access.

PURPOSE: To compare the functional outcomes of patients undergoing arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) performed with either the classic or the outside-in access to the hip. METHODS: Data regarding patients arthroscopically treated for FAI from January 2009 to June 2013 were retrospectively reviewed and compared regarding the type of access. RESULTS: 101 hips (91 patients) with a minimum of 12 months follow-up (mean 22 months, range 12-40 months) were included. Classic access was used in 48 cases while outside-in access was performed in 53 cases. Mean age was 37 years (range 15.7-59.6 years). Both groups were comparable with respect to preoperative characteristics. Mean operating time was 162 minutes for the outside-in group and 172 minutes for the classic access group. Complications between both groups showed no statistically significant differences but for the presence of heterotopic calcifications, which was more frequently observed regarding the outside-in access. Outcomes measured by the modified Harris Hip Score showed no overall differences regarding both types of access, except for patients under 35 years old, where there was a statistically significant increase in excellent and good outcomes with the use of the classic access in comparison to the outside-in technique. Postoperative hip motion was also significantly higher in the classic access group. CONCLUSIONS: No differences have been found in outcomes regardless the access used. Classic access seems to offer a higher postoperative range of motion and lower risk of heterotopic ossifications.