Prosthetic joint infection caused by Mediterraneibacter gnavus following total knee arthroplasty, challenges in anaerobic bacteria identification.

BACKGROUND: Mediterraneibacter gnavus is a Gram positive, non-sporulated, obligate anaerobe diplococci. It was first described in 1974 by Moore et al. (under the name Ruminococcus gnavus) from faeces and contents of the gastrointestinal tract of humans. It is a relatively common member of the human gut microbiota, nevertheless its role as a pathogenic bacterium has not been completely elucidated yet and it seems to depend on numerous factors, including those of the host. Here we present a case of prosthetic joint infection following total knee arthroplasty by M. gnavus. CASE PRESENTATION: A 74 years old patient was admitted to the emergency department presenting with acute onset of left knee pain and swelling 20 days after total left knee arthroplasty. Follow-up revealed erythema and oedema without signs of fluctuation or purulent discharge from the surgical wound and elevated inflammatory reactants. Synovial fluid was taken for bacterial culture and antibiotic treatment with ceftazidime and daptomycin was established. Examination of the synovial fluid revealed abundant polymorphonuclear leucocytes, without visualizing bacteria. After four days of incubation, anaerobic culture exhibit growth of small, grey, umbilicated colonies in pure culture on Schaedler agar. The microorganism was identified as R. gnavus by MALDI-TOF (Bruker Daltonics) and M. gnavus by 16S ribosomal bacterial sequencing. The isolated showed susceptibility to the most commonly used anaerobicidal antibiotics except for clindamycin. Surgical treatment and infection source control included DAIR (debridement, antibiotics, and implant retention) and vacuum assisted therapy. The patient was discharged after six weeks with a 3-month course of oral amoxicillin as consolidation therapy. Subsequent follow-up revealed adequate wound healing with no signs of infection. CONCLUSIONS: Mediterraneibacter gnavus have been reported as the causal microorganism in a range of human infections, nevertheless its identification remains challenging. Infection of prosthetic joints by anaerobic microorganisms is uncommon and is not considered in its empirical antibiotic treatment, thus, correct and swift identification of anaerobic bacteria in these cases is paramount.

[Labial adhesions: review of the literature]. / Sinequia vulvar: revisión de literatura.

INTRODUCTION: Fusion of the labia or sinequia vulvae is a common and benign finding in the pediatric female population. The reported incidence is 0.3-3.3% with a greater incidence between 3 months and 6 years old. OBJETIVE: Extensive review of the current international literature regarding the risk factors, etiology, treatment and prognosis. MATERIALS AND METHODS: A systematic search in medical databases as PubMed, Embase and Science Direct for the papers published between January 1999 and October 2016. RESULTS AND CONCLUSIONS: Labial adhesion is a multicausal benign pathology and there were very few published studies in Latin America. The proposed lines of treatment are observation and periodic follow up, topical treatment and manual or surgical separation. Topical conjugated estrogens have a success rate of 50-90% with recurrence of 30% and topical corticoids reported 68-80% of success with 23% of recurrences. Surgical intervention has a success rate of 100% and recurrence of 10%.

INTRODUCCIÓN: La fusión de los labios menores o sinequia vulvar es un hallazgo común y benigno. La incidencia se encuentra entre 0,3% y 3,3%. La edad de mayor incidencia es de los 3 meses a los 6 años. OBJETIVO: Realizar una revisión de la literatura internacional sobre factores de riesgo, etiología, tratamiento y pronóstico de la sinequia vulvar. MATERIALES Y MÉTODOS: Búsqueda sistemática en bases de datos PubMed, Embase y ScienceDirect con revisiónde artículos de enero de 1999 a octubre de 2016. RESULTADOS Y CONCLUSIONES: La sinequia vulvar es una patología benigna multifactorial y existen pocos estudios en Latinoamérica. Las líneas de tratamiento son observación y seguimiento, medicación tópica y separación manual o quirúrgica. Los estrógenos conjugados presentan una tasa de éxito del 50-90% con recurrenciadel 30%; los corticoides tópicos tienen una tasa de éxito del68-80% yrecurrencia del 23%. La intervención posee una tasa de éxito del 100% y de recurrencia de 10%.

Experiencia en la implementación de un protocolo para el tamizaje de escoliosis idiopática del adolescente en instituciones educativas de Bogotá / Implementation of a Protocol for Idiopathic Adolescent Scoliosis Screening. A Successful experience / Implementação de um protocolo para rastreamento de escoliose idiopática do adolescente. Uma experiência de sucess

Introducción: La escoliosis idiopática del adolescente es una deformidad tridimensional de la columna vertebral con un ángulo >10° en el plano coronal, medido por el método de Cobb, y que afecta a la población entre 10 y 18 años. Aunque se desconocen los mecanismos precisos que llevan a la presentación de esta deformidad, se sugiere que presenta un patrón de herencia autosómico dominante con penetrancia incompleta. Las curvas <20° reciben manejo expectante, las curvas entre 21° y 39° reciben manejo ortésico y el resto de curvas tendrían indicación quirúrgica. Debido a la complejidad y el costo de la cirugía, el beneficio del tratamiento ortésico y el impacto negativo en la calidad de vida de los pacientes que un diagnóstico tardío puede traer, se ha sugerido la implementación de programas para la detección temprana de esta patología. Objetivos: Narrar de forma breve la experiencia en la aplicación, así como las incidencias y los resultados preliminares, de un protocolo de investigación para el tamizaje de escoliosis. Desarrollo de la experiencia: Durante 2016 se tamizó a 387 estudiantes de dos instituciones educativas de la ciudad de Bogotá. La prevalencia de sospecha de escoliosis fue del 41,3 %. No hubo correlación entre la evaluación de los profesores con los médicos. Solo el 15 % de los participantes asistió a la cita para diagnóstico con especialista en columna; sin embargo, el 76 % de estos presentaron un diagnóstico asociado a deformidad de la columna vertebral. Se añadió una nueva institución para aumentar el impacto social del estudio. Discusión: El alto porcentaje de estudiantes que se beneficiaron de un diagnóstico temprano y la instauración de tratamiento aboga a favor y permite sugerir la utilidad de estos programas de tamizaje; sin embargo, se requiere mayor reconocimiento del problema y más sensibilización por parte de las instituciones educativas para participar en los programas.

Introduction: Idiopathic Adolescent Scoliosis is a tridimensional deformity of the vertebral spine with an angle greater than 10° measured in the plain view; it is presented in children between 10 and 18 years. Although exact mechanisms by which scoliosis is produced are unknown, it has been suggested that it follows an autosomal dominant pattern of inheritance with incomplete penetrance. Curves less than 20° receive expectant treatment, between 21 and 39° orthotic management and the rest have surgical indication. Given the complexity and the cost of surgical procedure, the possible benefits of orthotic treatment and the negative impact in life quality of a delayed diagnosis, screening programs had been implemented for early diagnosis worldwide. Objetive: To briefly narrate the experience, incidences and preliminary results in the application of a protocol to screen for idiopathic scoliosis. Develop: in 2016, 387 students were screened in two institutions. Prevalence of a positive screening were 41, 3 %. There was no correlation between teacher and doctors' assessments. Only 15 % of participants assist to control appointment at the hospital; however, 76 % of those who assist were found with a spinal deformity. A new institution was recruited in order to enhance the social impact of our work. Discussion: The great amount of students who benefited from an early diagnosis and treatment, allows us to suggest that screening programs like this one are useful; however it requires increase awareness of the problem by schools and parents in order to achieve full involvement.

Introdução: A escoliose idiopática do adolescente é uma deformidade tridimensional da coluna vertebral com um ângulo superior a 10° medido na vista plana; é apresentado em crianças entre 10 e 18 anos. Embora os mecanismos exatos pelos quais a escoliose é produzida sejam desconhecidos, foi sugerido que ela segue um padrão de herança autossômica dominante com penetrância incompleta. Curvas inferiores a 20° recebem tratamento expectante, entre 21 e 39° de tratamento ortopédico e o restante tem indicação cirúrgica. Dada a complexidade e o custo do procedimento cirúrgico, os possíveis benefícios do tratamento ortótico e o impacto negativo na qualidade de vida de um diagnóstico tardio, foram implementados programas de triagem para o diagnóstico precoce em todo o mundo. Objetivo: narrar brevemente a experiência, incidências e resultados preliminares na aplicação de um protocolo para a triagem de escoliose idiopática. Desenvolver: em 2016, 387 alunos foram selecionados em duas instituições. A prevalência de uma triagem positiva foi de 41, 3%. Não houve correlação entre as avaliações de professores e médicos. Apenas 15% dos participantes auxiliam no controle da consulta no hospital; no entanto, 76% dos que assistiram foram encontrados com uma deformidade da coluna vertebral. Uma nova instituição foi recrutada para aumentar o impacto social do nosso trabalho. Discussão: A grande quantidade de estudantes que se beneficiaram de um diagnóstico e tratamento precoces permite sugerir que programas de triagem como este são úteis; no entanto, exige maior conscientização do problema por parte das escolas e dos pais, a fim de alcançar o envolvimento total.