Assessment and diagnosis of the acute hot joint: a systematic review and meta-analysis.

OBJECTIVES: Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential for avoiding unnecessary antibiotics and hospital admissions. We evaluated the utility of synovial fluid (SF) and serum tests in differentiating causes of acute hot joints. METHODS: We performed a systematic literature review of diagnostic testing for acute hot joints. Articles were included if studying ≥1 serum or SF test(s) for an acute hot joint, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. The following were recorded for each test, threshold and diagnosis: sensitivity, specificity, positive/negative predictive values and likelihood ratios. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity, and areas under the curves. RESULTS: A total of 8443 articles were identified, and 49 were ultimately included. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most had been tested at multiple diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and thresholds, meta-analysis was possible for only eight SF tests, all differentiating septic from non-septic joints. Of these, leucocyte esterase had the highest pooled sensitivity [0.94 (0.70, 0.99)] with good pooled specificity [0.74 (0.67, 0.81)]. CONCLUSION: Our review demonstrates many single tests, individually with diagnostic utility but suboptimal accuracy for exclusion of native joint infection. A combination of several tests with or without a stratification score is required for optimizing rapid assessment of the hot joint.

A suplementação com óleo de peixe três vezes mais concentrado em epa (ácido eicosapentaenoico) modifica a função renal em ratos / Supplementation with fish oil three times more concentrated in epa (eicosapentaenoic acid) modifies renal function in rats

Objetivos: o óleo de peixe, rico em ácido eicosapentaenoico (EPA), mostrou benefícios renoprotetores em modelos animais de doenças crônicas. O objetivo deste trabalho foi avaliar os efeitos da suplementação com óleo de peixe três vezes mais concentrado em EPA (EPA 3X) na função renal de ratos e a eficiência desta suplementação por um curto período de tempo. Metodologia: ratos Wistar (n=16) foram divididos em dois grupos, controle (C) e suplementado (CO) por 14 dias com óleo de peixe (EPA 3X). Foram determinados os seguintes parâmetros: ganho de peso, ingesta de água e ração, fluxo urinário, proteinemia, trigliceridemia, osmolaridade, clearance de creatinina e fração de excreção de sódio. Resultados: os ratos suplementados tiveram níveis de triglicerídeos no plasma 58,4% menores que os ratos controle (p=0,0239), entretanto os restantes dos parâmetros sistêmicos avaliados não apresentaram alterações. A suplementação com óleo de peixe não alterou o fluxo urinário. Entretanto, no grupo CO identificou-se um aumento na filtração glomerular, com um incremento em média de 67,8% no clearance de creatinina em relação ao grupo C (p=0,054). A excreção média de proteínas totais na urina e a fração de excreção de sódio foram semelhantes entre os grupos. Conclusão: a suplementação com óleo de peixe três vezes mais concentrado em EPA por um período curto de tempo (quinze dias) provocou alterações significativas tanto em parâmetros sistêmicos (redução significativa na trigliceridemia) quanto na função renal de ratos controle (incremento na filtração glomerular) indicando a eficiência desta suplementação.

Objective: Fish oil, rich in eicosapentaenoic acid (EPA), has shown renoprotective benefits in animal models of chronic diseases. The objective of this work was to evaluate the effects of supplementation with fish oil three times more concentrated in EPA (EPA 3X) on renal function of rats and the efficiency of this supplementation for a short period of time. Methodology: Wistar rats (n=16) were divided into two groups, control (C) and supplemented (CO), supplemented for 14 days with fish oil (EPA 3X). The following parameters were determined: weight gain, water and feed intake, urinary flow, proteinemia, triglyceridemia, osmolarity, creatinine clearance and fractional sodium excretion. Results: The supplemented rats had plasma triglyceride levels 58.4% lower than control rats (p = 0.0239), however the rest of the evaluated systemic parameters did not change. Fish oil supplementation did not alter urinary flow. However, in the CO group an increase in glomerular filtration was identified, with an increase of 67.8% on average in creatinine clearance compared to group C (p = 0.054. The mean excretion of total proteins in the urine and the fractional sodium excretion were similar between groups. Conclusion: Supplementation with fish oil three times more concentrated in EPA for a short period of time (fifteen days) caused significant changes both in systemic parameters (significant reduction in triglyceridemia) and in the renal function of control rats (increase in glomerular filtration) indicating the efficiency of supplementation.